G Canguilhem The Normal and The Pathological

The Normal
and the Pathological

Translated by Carolyn R. Fawcett
in collaboration with Robert S. Cohen
The Normal
and the Pathological
Georges Canguilhem
with an introduction by
Michel Foucaul t
ZONE BOOKS NEW YORK
1991
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New York, NY 10012
First Paperback Edition
Fourth PrintinB 1998
All rights reserved
No part of this book may be reproduced, stored in a
retrieval system, or transmitted in any form or by
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copying, microflming, recording, or otherwise
(except for that copying permitted by Sections 107
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of the U. S. Copyright Law and except by
reviewers for the public press) without written
permission from the Publisher.
Originally published in 1966 as Le normal et le
patholoBique 1966 by Presses Universitaires de
France. Originally published in the English language
and 1978 by D. Reidel Publishing Company,
Dordrecht, Holland.
Printed in the United States of America
Distributed by The MIT Press,
Cambridge, Massachusetts, and London, England
Library of Congress Cataloging-in-Publication Data
Canguilhem, Georges, 1904-
The normal and the pathological.
Translation of: Le normal et le pathologique.
Reprint. Originally published: On the normal
and the pathological. Dordrecht, Holland; Boston:
D. Reidel, 1978.
Includes bibliographies and index.
1. Pathology-Philosophy. 2. Medicine-Philosophy.
I. Title.
RB1l2.Q13 1989 616.07'01
ISBN 0-
942299-5
9-0 (pbk.
)
88
-
20626
Contents
Introduction by Michel Foucault 7
Foreword 25
SECTION ONE ESSAY ON SOME PROBLEMS CONCERNING THE
NORMAL AND THE PATHOLOGICAL
Preface to the Second Edition 29
Introduction 33
|artOne | stbe|atbological>tateVerelyaQuantitative
VodifcationoftbeNormal>tate?
Introduction to the Problem 39
Il Auguste Comte and "Broussais' Principle" 47
III Claude Berard and Expermental Pathology 65
IV The Conceptions of Rene Lerche 91
V Implications of a Theory 103
|artTwo Lo>ciencesoftbeNormalandtbe
|atbologicalLxist?
Introduction to the Problem 115
Il A Crtical Examination of Certain Concepts 125
III Norm and Average 151
BOGAZici
UNivERSiTESi
KUTUPHANESi
1111 1 11111 11111 11 11
Ann1A
IV Disease, Cure, Health 181
V Physiology and Pathology 203
Conclusion 227
SECTION Two NEW REFLECTIONS ON THE NORMAL AND
THE PATHOLOGICAL
Twenty Years Later. . . 233
From the Social to the Vital 237
11 On Organic Norms in Man 257
III A New Concept in Pathology: Error 275
Epilogue 289
Notes 291
Glossar of Medical Terms 301
Bibliographies 307
Index of Names 321
Introduction
by
Michel Foucault
Lveryoneknows tbatin!rance tbere arefewlogicians butmany
bistorians of science, and tbat in tbe 'pbilosopbicalestablisb-
ment` wbetber teacbing or researcb oriented tbey bave
occupieda considerableposition.butdoweknowpreciselytbe
importancetbat,intbecourseoftbesepastbfteenortwentyyears,
uptotbeveryfrontiersoftbeestablisbment,a'workliketbat
ofCeorgesCanguilbemcanbavebadfortboseverypeoplewbo
wereseparatedhom,orcballenged,tbeestablisbment?Yes, I know,
tberebavebeennoisiertbeaters.psycboanalysis,Varxism,linguis-
tics, etbnology. but letusnotforgettbisfactwbicb depends, as
youwill,ontbesociologyof!rencbintellectualenvironments,tbe
functioningof ouruniversityinstitutionsoroursystemofcultural
values.inalltbepoliticalorscientihcdiscussionsoftbesestrange
sixtyyears past, tbe roleof tbe 'pbilosopbers I simply mean
tbosewbo bad receivedtbeiruniversitytraininginpbilosopby
departments basbeenimportant.perbapstooimportantfortbe
likingof certainpeople. And, directlyorindirectly, alloralmost
all tbese pbilosopbers bave badto 'come to terms witb tbe
teacbingandboos of Ceorges Canguilbem.
!romtbis,aparadox.tbisman,wboseworkisaustere,inten-
tionallyandcarefullylimitedtoaparticulardomainintbebistory
7
THE NORMAL AND THE PATHOLOGICAL
of science, wbicb in any case does not pass for a spectacular
discipline,bassomebowfoundbimselfpresentindiscussionswbere
bebimself took care never to hgure. but takeaway Canguilbem
andyouwillnolongerunderstandmucbaboutAltbusser,Altbus-
serismandawbole seriesof discussionswbicbbavetakenplace
among!rencbVarxists,youwillnolongergraspwbatisspecihc
tosociologistssucbasbourdieu,Castel,|assersonandwbatmarks
tbem so stronglywitbinsociology,youwill missanentireaspect
oftbetbeoreticalworkdonebypsycboanalysts,particularlybytbe
followersofLacan.lurtber,intbeentirediscussionofideaswbicb
precededorfollowedtbemovementof ' 6, itiseasy to hnd tbe
place of tbose wbo,fromnearorfromafar, badbeentrained by
Canguilbem.
Witboutignoringtbecleavageswbicb,duringtbeselastyears
aftertbeendoftbewar, wereableto opposeVarxistsandnon-
Varxists, !reudians andnon-!reudians, specialists ina single
disciplineandpbilosopbers,academicsandnon-academics,tbeorists
and politicians, it does seem tome tbat one could hnd anotber
dividinglinewbicbcutstbrougballtbeseoppositions.|tistbeline
tbatseparatesapbilosopbyofexperience,ofsenseandofsubject
andapbilosopbyofknowledge,ofrationalityandofconcept.On
tbeoneband,
onenetworkistbatof>artreandVerleau-|onty,
andtbenanotberistbatofCavaills,bacbelardandCanguilbem.
|notberwords,wearedealingwitbtwomodalities accordingto
wbicbpbenomenologywastakenupin!rance,wbenquitelate
around l 910 ithnallybegantobe,ifnotknown, atleastrecog-
nized. Contemporarypbilosopbyin!rancebeganintboseyears.
Tbelecturesontranscendentalpbenomenologydeliveredinl 9z9
byUusserl(translatedbyCabrielle|eifferandLmmanuelLevinas
asMeditations cartesiennes, |aris,Colin, l 91 l , andbyLorionCairns
as Cartesian Meditations, Tbe Uague, Nijboff, l 960) marked tbe
moment. pbenomenologyentered !rance tbrougbtbat text. but
8
INTRODUCTION
itallowedof two readings. one, intbe directionofapbilosopby
oftbesubject andtbiswas>artre'sarticleontbeTranscendance
de L'Lgo ( l 91) andanotberwbicbwent back to tbe founding
principlesofUusserl'stbougbt. tboseofformalismandintuition-
ism, tboseof tbetbeoryof science, andin l 91Cavaills'stwo
tbeses ontbeaxiomatic method andtbeformation of set theory.
Wbatevertbeymaybavebeenaftersbifts,ramihcations,interac-
tions,evenrapprocbements,tbesetwoformsoftbougbtin!rance
baveconstitutedtwopbilosopbicaldirectionswbicbbaveremained
profoundly beterogeneous.
Ontbesurfacetbesecondoftbesebasremainedatoncetbe
mosttbeoretical,tbemostbentonspeculativetasksandalsotbe
mostacademic. Andyetitwas tbis form wbicbplayedtbemost
importantroleintbesixties,wbena'crisisbegan,acrisiscon-
cerning not onlytbe Universitybutalso tbestatus androle of
knowledge.Wemustaskourselveswbysucbamodeofre|lection,
followingitsown logic, could turnouttobesoprofoundly tied
to tbe present.
Undoubtedlyone of tbeprincipal reasons stems from tbis. tbe
bistoryof scienceavails itself of one of tbe tbemes wbicbwas
introducedalmostsurreptitiouslyinto lateeigbteentbcentury
pbilosopby.fortbehrsttimerationaltbougbtwasputinquestion
notonlyastoitsnature,itsfoundation,itspowersanditsrigbts,
butalso as to its bistory anditsgeograpby, as to its immediate
pastanditspresentreality,astoitstimeanditsplace.Tbisistbe
questionwbicbVendelssobnandtbenkanttriedtoanswerin l 7+
intbeBerlinische Monatschrit : 'WasistAularung?(Wbatis
Lnligbtenment?). Tbesetwotextsinaugurated a 'pbilosopbical
journalismwbicb,alongwitbuniversityteacbing,wasoneoftbe
majorforms of tbe institutionalimplantationof pbilosopby in
9
tbe nineteentbcentury(andwe know bowfertile itsometimes
was, as intbe l +0s inCermany).Tbeyalso openedpbilosopby
uptoawbole bistorico-criticaldimension. And tbis workalw+ys
involves twoobjectives wbicb infact,cannotbedissociatedand
wbicbincessantlyecbo oneanotber.ontbeoneband,tolookfor
tbemoment(initscbronology, itsconstituentelements, itsbis-
toricalconditions)wbentbeWestbrstassertedtbeautonomyand
sovereigntyofitsownrationality.tbeLutberanReformation,tbe
'Copernican Revolution, Cartesian pbilosopby, tbe Cali|ean
matbematizationofnature,Newtonianpbysics.Ontbeotberband,
toanalyzetbe'presentmomentand, intermsofwbatwas tbe
bistoryoftbisreasonaswellasofwbatcanbeitspresentbalance,
to look for tbat relationwbicbmust be establisbedwitb tbis
foundingact. rediscovery,takingupaforgottendirection,comple-
tionorrupture, return to anearliermoment, etc.
UndoubtedlywesbouldaskwbytbisquestionoftbeLnligbt-
enment,witbouteverdisappearing, hadsucba differentdestiny
inCermany, !ranceandtbeAnglo->axoncountries,wbybereand
tbereitwasinvestedinsucbdifferentdomains andaccordingto
sucbvariedcbronologies. Let us say in any case tbat Cerman
pbilosopbygaveitsubstanceaboveallinabistoricalandpolitical
re|lectiononsociety(witboneprivilegedmoment.tbeReformation,
and a centralproblem. religious experience inits relationwitb
tbeeconomyandtbestate),fromtbeHegelianstotbe!rankfurt
>cboolandtoLuk+cs, !euerbacb,Varx,NietzscbeandVaxWeber
itbearswitnesstotbis. |n!ranceitistbebistoryofsciencewbicb
basaboveallservedtosupport tbepbilosopbicalquestionof tbe
Lnligbtenment.afterall,tbepositivismofComteandbissuccessors
wasonewayofonceagaintakinguptbequestioningbyVendels-
sobn and kant on tbe scale of a general bistory of societies.
knowledgebelief,tbescientibcformofknowledgeandtbereligious
contentsofrepresentation,ortbetransitionfromtbepre-scientibc
1 0
INTRODUCTION
orscientihc,tbe constitutionofarationalwayofknowingontbe
basis of traditional experience,tbeappearance,intbemidstofa
bistoryofideasandbeliefs,ofatypeofbistorysuitabletoscientihc
knowledge,tbeoriginandtbresboldofrationality itisundertbis
form,tbrougbpositivism(andtboseopposedtoit),tbrougbLubem,
|oincar,tbenoisydebatesonscientismandtbeacademicdis-
cussionsaboutmedievalscience,tbattbequestionoftbeLnligbt-
enmentwasbrougbtinto!rance.Andi pbenomenology,aherquite
along period wben itwas kept attbebordet, hnallypenetrated
in its turn, itwas undoubtedly tbe day wben Uusserl, in tbe
Cartesian Meditations andtbeCrisis (The Crisis of European Sciences
and Transcendental Phenomenology, translatedbyLavidCarr,Lvan-
ston,|ll . , NortbwestemUniversity|ress, 1 970), posedtbequestion
of tbe relations between tbe 'Western projectof a universal
development of reason, tbe positivityof tbe sciences and tbe
radicality of pbilosopby.
|f|baveinsistedon tbesepoints,itisto sbowtbatforacentury
andabalftbebistoryofsciencein !rance carried pbilosopbical
stakeswitbinitselfwbicbareeasilyrecognized.Workssucbastbose
ofkoyr,bacbelardorCanguilbemcouldindeedbavebadastbeir
centersof referenceprecise, 'regional, cbr ologicallywell-
dehneddomainsintbebistoryofsciencebuttbeybavemnctioned
asimportantcentersofpbilosopbicalelaborationtotbeextenttbat,
underdifferentfacets, tbey seti ntoplay tbis questionof tbe
Lnligbtenmentwbicbisessential to contemporarypbilosopby.
|f we were to lookoutside of !rance for sometbingcorres-
pondingtotbeworkofCavaills,koyr,bacbelardandCanguil-
bem,itisundoubtedlyintbe!rankfurt>cbooltbatwewouldhnd
it.Andyet,tbestylesarequitedilIerent.tbewaysofdoingtbings,
tbedomaios treated. butintbeendbotbpose tbesamekindof
questions,evenifberetbeyare bauntedbytbememoryofLes-
cartes,tberebytbegbostofLutber.Tbesequestioningsaretbose
1 1
wbicb must beaddressedtoarationalitywbicb makes universal
claimswbiledevelopingincontingency,wbicbassertsitsunityand
yetproceedsonlybymeansofpartialmodihcation wbennotby
general recastings, wbicb autbenticates itself tbrougb its own
sovereigntybutwbicbinitsbistoryisperbapsnotdissociatedfrom
inertias,weigbts wbicb coerce it, subjugate it. |ntbebistory of
science in !rance as in Cerman critical tbeory, wbat we are to
examine essentially isa reason wbose autonomyof structures
carrieswitbitselftbebistoryofdogmatismsanddespotisms a
reason wbicb, consequently, bas tbeeectofemancipationonly
on tbe conditiontbatitsucceeds infreeing itself of itself.
>everalprocesses,markingtbe second balfof tbetwentietb
century, baveledtotbebeartof contemporarypreoccupations
concerning tbe question of tbe Lnligbtenment. Tbe hrst is tbe
importanceacquiredbyscientib candtecbnicalrationalityintbe
development of tbe productive forces andtbe play of political
decisions.Tbesecondistbeverybistoryofa'revolutionwbose
bope, since
tbe closeof tbeeigbteentbcentury, badbeenborne

byarationalismtowbicbweareentitledtoask,wbatpartitcould
baveintbe effects of a despotism wberetbatbopewas lost.
Tbe tbird andlast is tbemovementbywbicb, attbeendof
tbe colonial era, people began to ask tbe Westwbat rigbts its
culture,itsscience,itssocialorganizationandbnallyitsrationality
itself couldbavetolayingclaimtoauniversalvalidity.isitnota
mira
]
etiedtoaneconomicdominationandapoliticalbegemony?
Twocenturieslater tbeLnligbtenmentreturns.but notatallasa
wayfortbe Westto becomeconsciousof its actual possibilities
and1reedomstowbicbitcanbaveaccess, butasawaytoques-
tion tbe limits andpowersit bas abused. Reason tbedespotic
enligbtenment.
Letusnotbesurprisedtbattbe bistoryofscience,above all
intbeparticularformgivenitbyCeorgesCanguilbem,couldbave
1 2
INTRODUCTION
occupiedsocentralaplaceincontemporarydiscussionsin!rance,
even if bis role bas remained ratberbidden.
|ntbebistoryofscience,sucbasitwaspracticedin!rance,Ceorges
Canguilbem brougbt about a signihcant sbift. broadly speaking,
tbebistoryof science concerneditselfbypreference, if notex-
clusively, witb disciplines wbicb were 'noble intermsof tbe
antiquityof tbeirfoundation,tbeirbigbdegreeofformalization
andtbeirhtness for matbematization,intermsoftbeprivileged
positiontbeyoccupiedintbepositivistbierarcbyoftbesciences.
Toremain close to tbese sciences wbicb, ftom tbe Creeks to
Leibniz,bad, insbort, been anintegralpartof pbilosopby, tbe
bistoryof sciencebidwbatitbelieved itwasobliged to forget.
tbatitwasnotpbilosopby Canguilbembasfocusedalmostallbis
workon tbe bistoryof biologyandmedicine,knowingfullwell
tbat tbe tbeoretical importance of tbe problems raisedby tbe
developmentofasciencearenotperforceindirectproportionto
tbe degree of formalization reacbed by it. Tbus bebrougbt tbe
bistoryofsciencedownfromtbebeigbts(matbematics,astronomy,
Calileanmecbanics,Newtonianpbysics,relativitytbeory)toward
tbemiddleregionswbereknowledgeismucbless deductive,mucb
moredependentonexternalprocesses(economicstimulationsor
institutionalsupports)andwbereitbasremainedtiedmucblonger
to tbe marvels of tbe imagination.
but inbringing about tbis sbift, Canguilbem didmore tban
assuretberevaluationofarelativelyneglecteddomain.Uedidnot
simplybroadentbeheldof tbebistoryof science. berecasttbe
disciplineitself ona certainnumberof essential points.
1. Uetookupagaintbetbemeof 'discontinuity anoldtbeme
wbicbstoodoutveryearly, totbepointofbeingcontemporary,
oralmost, witb tbe birtb oftbebistoryofscience. Wbat marks
sucbabistory, !ontenellesaid,istbesuddenformationofcertain
sciences 'starting from notbing, tbeextremerapidity of some
progresswbicbwasbardlyexpected,tbedistanceseparatingsci-
entib cknowledgefrom 'commonusageandtbemotiveswbicb
couldstimulatescientists,andfurtbermore,tbepoteotialformof
tbis bistory wbicb does notstop recountingtbe battles against
'prejudices,'resistancesand'obstacles. ' |ntakinguptbissame
tbemeelaboratedbykoyrandbacbelard,Canguilbeminsiststbat
forbimmarkingdiscontinuitiesisneitberapostulatenoraresult,
butratbera 'wayof doing, a process wbicbisanintegralpart
oftbebistoryofsciencebecauseitissummonedbytbeveryobject
wbicbmustbetreatedbyit. |nfact,tbisbistoryofscienceisnot
abistoryoftbetrue,ofitsslowepipbany,itwouldnotbeableto
claimtbatitrecountstbeprogressivediscoveryofatrutb'inscribed
foreverintbingsorintbeintellect, excepttoimaginetbatcon-
temporaryknowledgehnallypossessesitsocompletelyanddehn-
itivelytbatitcanstartfrom ittomeasuretbepast. Andyettbe
bistoryof science isnota pureandsimplebistoryof ideasand
tbeconditionsinwbicbtbeyappearedbefore beingobliterated.
|ntbe bistoryof science tbe trutb cannotbegivenas acquired,
butonecannolongereconomizeon a relationtotbe trutb and
tbetruefalse opposition. |t istbis reference to tbe 'truefa|se
wbicbgivestbisbistoryitsspecihcityandimportance.|nwbatform?
by conceiving tbat one isdealingwitb tbe bistoryof 'trutbful
discourses, tbat is,discourseswbicbrectify, correcttbemselves
and wbicb effecton tbemselves a wbole work of elaboration
hnalizedbytbetaskof'speakingtrue. Tbebistoricaltiewbicb
tbe dilIerent moments of science can bave witb one anotber
necessarilybastbisformofdiscontinuityconstitutedbytbealter-
ings,resbapings,elucidationsofnewfoundations,cbangesinscale,
tbe transition to a new kind of object 'tbe perpetual revision
1
4
INTRODUCTION
of contents tbrougbtborougbexaminationandamendment, as
Cavaillssaid.Lrrorisnoteliminatedbytbemuf|ledforceofatrutb
wbicbgraduallyemergesfrom tbe sbadow but by tbeformation
ofanewwayof'speakingtrue.
,,
Oneoftbeconditionsofpossi-
bility because of wbicba bistoryof science was formed at tbe
beginningoftbeeigbteentbcenturywas,asCanguilbemnotes,tbe
awarenesstbattberebadbeenrecentscientihc'revolutions. tbat
ofalgebraicgeometryandtbeinhnitesimalcalculus,ofCopernican
and Newtonian cosmology.3
z. Wboeversays'bistoryoftrutbfuldiscoursealsosaysrecurrent
metbod,notintbesensewberetbebistoryofsciencewouldsay.
lettbetrutbbehnallyrecognizedtoday,bowlongbasoneforeseen
it,wbatpatbsbadtobefollowed,wbaterrorsavertedtodiscover
itandproveit?butintbesensetbattbesuccessivetransformations
oftbistrutbfuldiscoursecontinuouslyproduceresbapingsoftbeir
ownbistory,wbatbadforalongtimeremainedadeadend,today
becomes an exit, a 'side attemptbecomes a central problem
aroundwbicb all tbe otbersgravitate, a sligbtlydivergent step
becomesafundamentalbreak.tbediscoveryofnon-cellularfer-
mentation a 'side pbenomenon during tbe reign of |asteur
andbismicrobiology markedanessentialbreakonlywbentbe
pbysiologyofenzymesdeveloped. |nsbort,tbebistoryofdiscon-
tinuitiesisnotacquiredonceandforall,itisitself'impermanent
anddiscontinuous.
Vustweconcludefrom tbistbatsciencespontaneouslymakes
andremakesitsownbistoryateveryinstant,totbepointtbattbe
onlyautborizedbistorianofasciencecouldbetbescientistbimself,
reconstituting tbe past of wbat be was engaged in doing?Tbe
problemforCanguilbemis not a matter of a profession. it isa
matterofpointofview.Tbebistoryofsciencecannotbecontent
witbbringingtogetberwbat past scientists were able to believe
ordemonstrate, a bistoryofplantpbysiologyis not writtenby
amassing
everytbingtbat people called botanists, pbysicians, cbemists,
borticulturists, agronomists, economists couldwrite down,
toucbingontbeirconjectures,observationsorexperienceswitb
regard to tbe relations between structure and function for
objects wbicb are sometimes calledgrass, sometimes plants,
sometimes vegetables.`
butonedoes notmakebistoryofscienceeitberbyrehlteringtbe
past tbrougbtbe set ofstatementsortbeories validnow,tbus
disclosinginwbatwas'falsetbetruetocome,andinwbatwas
true,tbeerrormademanifestlateron.Uereisoneoftbefunda-
mentalpointsofCanguilbem'smetbod.tbebistoryofsciencecan
consistinwbatitbastbatisspecihconlybytakingintoaccount
tbeepistemologicalpointofviewbetweentbepurebistorianand
tbe scientistbimself. Tbis point of viewis tbatwbicb causes a
'bidden,orderedprogressiontoappeartbrougbdifferentepisodes
ofscientihcknowledge.tbismeanstbattbeprocessesofelimination
andselection of statements, tbeories, objectsare made ateacb
instant i n terms of a certain norm, and tbis norm cannot be
identihedwtbatbeoreticalstructureoranactualparadigmbecause
today's seientihc trutb isitself onlyanepisodeofit let us say
provisionalatmost. |tisnotbydependingona 'normalscience
inT>. kubn's sense tbatone canreturnto tbe pastandvalidly
trace its bistory. itisinrediscoveringtbe 'normprocess, tbe
actualknowledgeofwbicbisonlyonemomentofit,witboutone
beingable,saveforpropbesying,topredicttbefuture.Tbisbistory
ofscience,saysCanguilbemquoting>uzannebacbelard,cancon-
structitsobjectonly'inanidealspace-time. Andtbisspace-time
isgiven to tbe bistory of science neitberby tbe 'realist time
1 6
INTRODUCTION
accumulatedbytbebistorian'seruditionnorbytbeidealizedspace
autboritativelycutoutbytoday'sscience,butbytbepointofview
ofepistemology. Tbelatterisnottbegeneraltbeoryofallscience
orof every possiblescientihcstatement,itistbesearcbfornor-
mativitywitbin differentscientihcactivities, sucb tbattbeybave
effectivelybeen brougbt into play. Uenceweare dealingwitban
indispensabletbeoreticalre|lectionwbicbabistoryofsciencecan
form for itself in a way dilIerentfrom bistory ingeneral, and
conversely, tbebistoryof science opens up tbe areafor analysis
wbicbisindispensableinorderforepistemologytobesometbing
otbertban tbesimplereproductionofscbemeswitbinascience
at a givenmoment. |n tbe metbod used by Canguilbem, tbe
elaborationof'discontinuistanalysesandtbeelucidationoftbe
bistoryof science/epistemology relationgoband inband.
1.Now,inplacingtbelifescienceswitbintbisbistorico-epistemo-
logicalperspective, Canguilbembrings toligbta certainnumber
ofessentialtraitswbicbsingleouttbedevelopmentof tbese sci-
ences,andfortbeirbistorianstbeyposespecihcproblems.Onebad
been able to believe aroundtbe time of bicbattbatbetween a
pbysiology studying tbepbenomenaoflifeanda patbology dedi-
catedtotbeanalysisofdiseases,onewashnallyabouttodisentan-
glewbatbadremaine1conmsedforalongtimeintbemindoftbose
wbowerestudyingtbebumanbodyinorderto'cureit,andtbat
bavingtbusbeenfreedfromeveryimmediatecareofpracticeand
everyvaluej udgmentastotbegoodandevilfunctioningoftbeor-
ganism,one was hnallygoingtobeabletodevelopapure andrig-
orous'scienceoflife. butitprovedimpossibletomakeupascience
oftbelivingbeingwitboutbavingtakenintoaccount,asessential
toitsobject, tbepossibilityof disease,deatb,monstrosity, anom-
aly,error(evenifgeneticsgivestbislastwordameaningcompletely
differentnomtbatintendedbyeigbteentb-centurypbysicianswben
1
7
tbeyspokeofanerrorofnature). Yousee,tbelivingbeinginvolves
self-regulationandself-preservationprocesses,witbincreasingsub-
tletywecanknowtbepbysico-cbemicalmecbanismswbicbassure
tbem. tbey nonetbelessmarka specihcity wbicbtbelife sciences
musttake intoaccount,savefor tbemselvesomittingwbatprop-
erlyconstitutes tbeir object and tbeirowndomain.
Uence a paradoxical factintbe life sciences. itistbat if tbe
'scientihcizationprocessisdonebybringingtoligbtpbysicaland
cbemicalmecbanisms,bytbeconstitutionofdomainssucbastbe
cbemistryofcellsandmoleculesorsucbasbiopbysics,bytbeuti-
lizationofmatbematicalmodels,etc. , itbasontbeotberband,been
able todeveloponlyinsofar as tbeproblemof tbespecihcityof
life and of tbe tbresbolditmarksamongallnaturalbeingswas
continuallytbrownbackasacballenge. 'Tbisdoesnotmeantbat
'vitalism, wbicbbascirculatedsomanyimagesandperpetuated
somanymytbs,istrue. |tdoesnotmeantbattbisidea,wbicbbas
beensooftenrooted in less rigorous pbilosopbies,mustconsti-
tutetbeinvinciblepbilosopbyofbiologists. | tsimplymeanstbat
itbasbadandundoubtedlystillbasanessentialroleasan'indi-
cator intbe bistoryof biology. And tbis intworespects. as a
tbeoretical indicatorof problems to besolved(tbatis,wbat, in
general,constitutestbeoriginalityoflifewitbout,inanyway,con-
stitutinganindependentempireinnature),asacriticalindicator
of reductions to beavoided(tbat is, alltbosewbicbtendto ig-
noretbefacttbattbelifesciencescannotdowitboutacertainpo-
sitionof value indicatingpreservation, regulation, adaptation,
reproduction,etc. ). 'Ademandratbertbanametbod,amora|ity
more tban a tbeory.
, ,
Lnlargingontbepoint,we couldsaytbat tbeconstantprob-

lem inall Canguilbem's work, from tbeEssai sur le normal et le
pathologique of 1 943 toIdeologie et rationalite dans l'histoire des sci
ences de la vie (|deologyandRationalityintbeUistoryoftbeLife
1 8
INTRODUCTION
>ciences)of 1 977, bas beentbe relation betweenscienceof life
andvitalism.aproblemwbicbbetackledbotb insbowingtbeir-
reducibilityof tbe problem of diseaseas a problem essential to
everyscienceoflife,andinstudyingwbatbasconstitutedtbespec-
ulative climate, tbe tbeoretical contextof tbelifesciences.
4. WbatCanguilbemstudiesinaprivilegedwayintbebistoryof
biologyistbe'formationofconcepts. Vostoftbebistoricalin-
vestigationsbebasconductedturnontbisconstitution.tbecon-
ceptofredex,environment,monsterandmonstrosity,cell,intemal
secretion,regulation. Tbereare several reasons fortbis. !irst of
all,itisbecausetberoleofastrictlybiologicalconceptistocut
outfrom tbeensembleof tbepbenomena'oflifetbosewbicb
allowone,witboutreducing,toanalyzetbe processesproperto
livingbeings(tbus,amongalltbepbenomenaofresemblance,dis-
appearance,mingling,recurrencepropertoberedity,tbeconcept
of'bereditarytraitbasbrougbtaboutasimilar'cuttingout).
tbereisnoobjectpertinenttobiologicalscienceunlessitbasbeen
'conceived. but, ontbeotberband,tbeconceptdoesnotcon-
stitutealimitwbicbcannotbetranscendedbyanalysis.ontbecon-
trary,itmustgiveaccesstoastructureofintelligibilitysucbtbat
elementaryanalysis(tbatof cbemistry orpbysics)allowsoneto
sbowuptbespecihcprocessesoftbelivingbeing(tbissamecon-
ceptoftbebereditarytraitledtoacbemicalanalysisoftbemecb-
anismsofreproduction). Canguilbeminsiststbatanideabecomes
abiological concept attbemomenttbereductiveeffects,wbicb
aretiedtoanexternalanalogy,becomeobliteratedfortbebeneht
ofa specihcanalysisof tbelivingbeing,tbeconceptof're|lex
was notformedas a biological conceptwben Willis applied tbe
imageof a redectedligbt ray toanautomaticmovement,but it
didbappentbeday|rocbaskacouldwriteitdownintbeanalysis
of sensorimotorfunctions andtbeircentralizationinrelationto
tbebrain. "Canguilbemwouldundoubtedlyallow onetosaytbat
tbemomentwbicbmustbeconsideredstrategicallydecisiveina
bistoryofpbysicsistbatoftbeformalizationandconstitutionof
tbe tbeory, buttbe moment tbat counts ina bistory of tbebio-
logicalsciencesistbatof tbeconstitutionof tbe objectandtbe
formation of tbe concept.
Tbe life sciences call for a certainmannerofmakingtbeir bis-
tory. |nasingularfasbiontbeyalsoposetbepbilosopbicalques-
tion of knowledge.
Lifeanddeatbareneverintbemselvesproblemsofpbysics,al-
tbougbinbisworkeventbepbysicistrisks bisownlifeortbatof
otbers,forbim tbese are questionsofmorals orpolitics, not o
science.AsA.Lwoff said, letbalornot,fortbepbysicistagenetic
mutation is neitber more nor less tban tbe substitutionof one
nucleicacidbaseforanotber.butitisintbisverydilIerencetbat
tbebiologistrecognizestbemarkofbisobject,andanobjectofa
typetowbicbbebimselfbelongs,sincebelives andbemanifests
tbenatureoftbelivingbeing,beexercisesit,bedevelopsitinan
activityofknowledgewbicbmust be understood as a 'general
metbodfortbedirectorindirectresolutionoftensionsbetween
manandtbeenvironment. Tbebiologistmustgraspwbatmakes
lifeaspecihcobjectofknowledgeandtberebywbatmakesitsucb
tbattbereareattbebeartoflivingbeings, because tbeyare liv-
ingbeings,somebeingssusceptibletoknowing,and, intbehnal
analysis, to knowinglife itself.
|benomenologyaskedofactualexperiencetbeoriginalmean-
ingof every act of knowledge. but can we not,ormustwe not
look forit in tbe living being bimself?
Canguilbem, tbrougbtbe elucidation of knowledgeconcern-
inglifeandtbeconceptswbicbarticulatetbisknowledge,wants
20
INTRODUCTION
torediscoverwbicb of tbembelongstotbeconcept c lie. Tbat
is,tbeconceptinsofarasitisoneoftbemodesoftbisinformation
wbicbeverylivingbeing leviesonbis environmentandbymeans
ofwbicb,ontbeotberband,bestructuresbisenvironment.Tbat
man lives ina conceptuallyarcbitecturedenvironmentdoes not
provetbatbebasbeendivertedfromlifebysomeoversigbtortbat
abistoricaldramabasseparatedbimfromit,butonlytbatbelives
inacertainway, tbatbebasarelationsbipwitbbisenvironment
sucbtbatbedoesnotbaveahxedpointofviewofit,tbatbecan
moveonanundehned territory, tbatbemustmoveabouttore-
ceiveinformation,tbatbemustmovetbingsinrelationtoonean-
otberinordertomaketbemuseful.!ormingconceptsisoneway
of living, not of killing life, itis one way of livingin complete
mobilityandnotimmobilizinglife,itissbowing,amongtbesemil-
lions of livingbeings wbo inform tbeirenvironmentandare in-
formedfromitoutwards,aninnovationwbicbwillbejudgedtri|ling
orsubstantialasyouwill. a very particular type of information.
UencetbeimportanceCanguilbemaccordstbemeeting,intbelife
sciences,of tbe old questionof tbe normal and tbe patbological
witbtbesetof notionstbatbiology, intbecourseoftbelastde-
cades,basborrowedfrominformationtbeory.code,messages,mes-
sengers,etc.!romtbispointofviewLe normal et le patholo8ique,
writteninpart in 1 943 and inpart intbeperiod 1 963-66, con-
stitutes witbout any doubt tbe most important and tbe most
signihcantofCanguilbem'sworks.Uereweseebowtbeproblem
of tbe specihcityoflife recentlyfound itself bentinone direc-
tionwberewemeetsomeoftbeproblems believedtobelongin
tbeirownrigbt to tbemost developedforms of evolution.
At tbe beart of tbese problems is tbatof error. !or at life's
most basic level, tbe playof code and decodingleaves room for
2 1
cbance,wbicb,beforebeingdisease, dehcitor monstrosity, issome-
tbinglikeperturbationintbeinformationsystem,sometbinglike
a'mistake. |ntbeextreme,lifeiswbatiscapableoferror.And
itisperbapstbisgivenorratbertbisfundamentaleventualitywbicb
mustbecalledto accountconcerningtbe facttbattbe question
ofanomalycrossesallofbiology, tbrougbandtbrougb.We must
alsocallittoaccountformutationsandtbeevolutionaryprocesses
tbeyinduce.Wemustalsocallittoaccountfortbissingularmu-
tation, tbis'bereditaryerrorwbicbmakesliferesult,witbman,
inalivingbeingwbo isnevercompletelyatbome,alivingbeing
dedicatedto'erroranddestined,intbeend,to'error. Andif
we admit tbat tbeconceptistbe answer tbat life itself gives to
tbis cbance, it must be tbat error is at tbe root of wbat makes
bumantbougbtandits bistory. Tbeoppositionof trueandfalse,
tbevaluesweattributetobotb,tbeeffectsofpowertbatdilIer-
entsocietiesanddifferentinstitutionslinktotbisdivision even
alltbisisperbapsonlytbelatestresponsetotbispossibilityoferror,
wbicbis intrinsictolife. |f tbe bistoryofscienceis discontinu-
ous,tbatis,ifitcanbeanalyzedonlyasaseriesof'corrections,
as a newdistributionof trueandfalsewbicbneverhnally, once
and for all, liberates tbetrutb, itis because tbere, too, 'error
constitutesnotoverlookingordelayingatrutbbuttbedimension
properto tbelifeof menandto tbe timeof tbe species.
Nietzscbesaidtbattrutbwastbemostprofoundlie.Canguil-
bem, wbo isatoncecloseto andfar from Nietzscbe, would say
perbapstbatontbeenormouscalendaroflife, itistbemost re-
centerror,bewouldsaytbattbetruefalsedivisionandtbevalue
accorded trutbconstitutetbemost singular wayof livingwbicb
couldbavebeeninventedbyalifewbicb,fromitsfurtbermostor-
igin,carriedtbe eventualityoferrorwitbinitself LrrorforCan-
guilbemistbepermanentcbancearoundwbicbtbebistoryoflife
2 2
INTRODUCTION
andtbatofmendevelops. |tistbis notionoferrorwbicballows
bimtojoinwbatbeknowsaboutbiologytotbewaybeworksits
bistorywitbouteverbavingwanted, aswas done attbe time of
evolutionism,todeducetbelatterfromtbeformer. |t istbisno-
tionwbicballowsbimtomarktbe relation between lifeandtbe
knowledge of life, andtofollow, likea redtbread, tbepresence
of value and norm.
Tbisbistorianofrationalities,bimselfa'rationalist,isapbi-
losopberoferror.|meantbatitisinstartingfromerrortbatbe
posespbilosopbicalproblems,|sbouldsay,the pbilosopbicalprob-
lemoftrutbandlife. Uerewetoucbonwbatisundoubtedlyone
oftbefundamentalevents intbebistoryofmodernpbilosopby.
if tbegreatCartesianbreak posed tbe questionof tberelations
between trutb and subject, tbe eigbteentb century, asfar as tbe
relationsoftrutbandlife are concerned,introduceda seriesof
questionsof wbicbtbeCritique of JudBment andtbePhenomenol-
0BY of Spirit were tbehrstgreatformulations.Andfrom tbenon
itwasone of tbe stakes of pbilosopbical discussions. is ittbat
knowledgeof lifemustbeconsideredasnotbingmoretbanone
oftberegionswbicbdepends ontbegeneralquestionof trutb,
subjectandknowledge?Orisittbatitobligesustoposetbisques-
tion dilIerently? |s ittbat tbe entire tbeory of tbe subject must
notbereformulated,since knowledge,ratbertbanopeningitself
uptotbetrutboftbeworld,isrootedintbe'errorsoflife?We
understandwby Canguilbem'stbougbt,bisworkas abistorianand
pbilosopber, couldbaveso decisive animportancein!rancefor
all tbosewbo,startingfromdifferentpointsof view(wbetbertbe-
oristsofVarxism,psycboanalysisorlinguistics),bavetriedtore-
tbinktbe questionof tbe subj ect. |benomenologycouldindeed
introducetbebody, sexuality,deatb,tbeperceivedworldintotbe
b eldof analysis, tbeCogitoremainedcentral,neitbertberatio-
2
3
nalityofsciencenortbespecihcityoftbelifesciencescouldcom-
promise its foundingrole. |t is to tbispbilosopby of meaning,
subjectandtbeexperiencedtbingtbatCanguilbembas opposed
apbilosopby of error, conceptand tbe livingbeing.
Foreword
Tbe presentworkunites two studies oneunpublisbed ontbe
samesubject.|tishrstare-editionofmydoctoraltbesisinmedi-
cine, made possiblebytbegracious consent of tbe |ublications
Committeeoftbe!acultyofLettersat>trasbourgfortbisproj ect
oftbe|ressesUniversitairesde!rance.Totbosewboconceived
tbe proj ectaswell asto tbose wbo furtbered its realization, |
express beremy beartfeltgratitude.
|tisnotformetosaywbetbertbisre-editionisnecessaryor
not.|tistruetbatmytbesiswasfortunateenougbtoarouseinterest
inmedicalaswellaspbilosopbicalcircles.|amleftwitbtbebope
tbat itwill notbejudgednow asbeingtoo outof date.
|naddingsome unpublisbed considerationstomy hrst Lssay
(>ection l ),|amonlytryingtofurnisbevidenceofmyefforts if
notmysuccess topreserveaproblem,wbicb|considermndamen-
tal, intbesamestateoffresbnessasitsevercbangingfactualdata.
C. C.
l 966
Tbi srevisededition contains corrections of somedetails and
somesupplementaryfootnotes indicatedby anasterisk
C. C.
l 97z
S E C T I O N ONE
E SSAY O N SOME PR O B L E MS
C O NC E R NI NG T H E NO R MA L A ND
T H E PAT H O L O G I C A L
(1943)
Pre face to th e
Second Edition
(1950)
Tbis secondedition of my doctoral tbesis in medicine exactly
reproducestbetextoftbehrst,publisbedin l 9+!.Tbisisbyno
meansbecauseofmy own dehnitive satisfactionwitbit. but, on
tbeoneband,tbe|ublicationsCommitteeoftbe!acultyofLetters
at >trasbourg wbom | very cordially tbank for baving decided
to reprintmy work could not aord tbe expense involvedin
cbangingtbetext.Ontbeotberband,tbecorrectionsoradditions
totbishrstessaywillbefoundinafuture,moregeneralwork. |
wouldonlyliketoindicateberetbosenewreadings,tbosecriticisms
wbicbbave been made,tbose personal re|lections witb wbicb |
could and sbouldbave enricbedtbe hrst version ofmy essay.
To beginwitb,evenin l 9+!|couldbavepointedoutwbatbelp
|couldhndfortbecentraltbemeofmyexpositioninworkssucb
as |radines' s Trai te de pscholoSie Senerale andVerleau-|onty's
Structure du comportement. |couldonlyindicatetbesecond,discov-
ered wben my manuscript was in press. I bad not yetread tbe
hrst. >ufhce itto recall tbe conditionsfordistributing books in
l 9+!inordertounderstandtbedifhcultiesof documentation at
tbattime. !urtbermore,| mustconfessI amnottoosorryabout
tbemas|mucbpreferaconvergencewbosefortuitouscbaracter
betterempbasizestbevalueof intellectual necessitytoanacqui-
escence, evenfullysincere, intbe view of otbers.
|f | were to write tbis essay today | would bave to devote a
greatdealofspaceto>elye'sworksandbis tbeoryoftbestateof
organic alarm. Tbis exposition could serve tomediatebetween
Lericbe'sandColdstein'stbeses(athrstglanceverydifferent)of
wbicb|bavetbebigbestopinion. >elyeestablisbedtbattbefailures
orirregularities of bebavior aswell as tbe emotionsandfatigue
tbeygenerate,producetbrougbtbeirfrequentrepetition,astruc-
turalmodihcationoftbeadrenalcortexanalogoustotbatdeter-
minedby tbe introduction of bormonal substances (wbetber
impureorpurebutinlarge doses)ortoxicsubstances into tbe
internalenvironment. Lveryorganicstateofdisorderedtension,
allbebaviorof alarmand stress, provoke adrenal reaction.Tbis
reaction is 'normal witbregardto tbe action andeffects of
corticosteroneintbeorganism.Voreover,tbesestructuralreactions,
wbicb>elyecallsadaptationreactionsandalarmreactions,involve
tbetbyroidorbypopbysis aswellastbeadrenalgland. but tbese
normal(tbatisbiologicallyfavorable)reactionsendupwearingout
tbeorganismintbecaseofabnormal(tbatisstatisticallyfrequent)
repetitions of situations wbicb generate tbe alarm reaction. |n
certainindividuals, tben, disadaptationdiseasesare setup. Tbe
repeated discbarge of corticosterone provokes eitberfunctional
disturbancessucbasvascularspasmandbypertensionormorpbo-
logicallesions sucbasstomacbulcer. Uenceintbepopulations of
Lnglisb villages subjectedto air raids intbelastwar, a notable
increaseincases ofgastriculcerwas observed.
|ftbesefactsareinterpretedfrom Coldstein's pointof view,
diseasewillbeseenincatastropbicbebavior,iftbeyareinterpreted
fromLericbe'spointofview,diseasewillbeseenintbedetermi-
nationofbistologicalanomalybypbysiologicaldisorder.Tbesetwo
points of view are not mutuallyexclusive, farfrom it.
Likewise, in tbe caseofmy references totbeproblemsof
3
0
PREFACE TO THE SECOND EDITION
teratogenesis,today| woulddrawagreatdealonLtienneWolff's
worksonLes changements de sexe andLa science des monstres. |would
insistmoreontbepossibilityandeventbeobligationofenbancing
tbe knowledge of normal formations byusingknowledge about
monstrousformations.|wouldproposemoreforcefullytbattbere
isnotinitselfana priori ontologicaldifferencebetweenasuccessml
livingformandanunsuccessfulform.Voreover,canwespeakof
unsuccessfullivingforms?Wbatlackcanbedisclosedinaliving
form aslongastbenatureofitsobligationsasaliviogbeingbas
notbeen determined?
|alsosbouldbavetakenintoaccountmoretbantbeapprovals
orconhrmationswbicbreacbedmenompbysicians,psycbologists,
sucbasmyfriendLagacbe,professorattbe>orbonne,orbiologists
sucbas>abianiandkeblattbeAlgiers!acultyofVedicine tbe
criticism,atoncecomprebensiveandhrm,ofLouis bounoureof
tbe !acultyof >ciencesat>trasbourg.|nbisL'autonomie de l'etre
vivant bounourereproacbesmewitbasmucb spiritascordiality
foryieldiogtotbe'evolutionistobsessionandconsiders,if|may
saywitbgreatperspicacity, tbeideaoftbelivingbeing'snormativity
as a projection onto all oflivingnature of tbebumantendency
towardtranscendence.Wbetberitislegitimateornottointroduce
Uistoryinto Life (| amtbinkingbereof Uegel andtbeproblems
raisedby tbe interpretation of Uegelianism) is indeed a serious
problem,atoncebiologicalandpbilosopbical.Understandablytbis
questioncannotbetackledinapreface.Attbeleast|wanttosay
tbatitbasnotescapedmyattention,tbat|bopetotackleitlater,
andtbat | amgrateful to bounourefor belpingme topose it.
!inally,itiscertaintbatinexpoundingClaudebernard'sideas
today,|couldnot4elptakingintoaccounttbepu|licationinl 9+7
byLr.LelboumeoftbePrincipes de midecine expeimentale, wbere
bernardismoreprecisetbanelsewbereinexaminingtbeproblem
oftbeindividualrelativityoftbepatbologicalfact. butessentially
3
1
| do not tbinktbatmyj udgment of bernard's ideas wou|d be
modihed.
|nconc|uding|wanttoaddtbatcertainreadersweresurprised
at tbe brevity of my conc|usions andattbe facttbat tbey |eave
tbepbi|osopbica|dooropen. | mustsaytbattbiswasintentiona|.
|badwantedto|aytbegroundworkforamturetbesisinpbi|osopby
|wasawareof bavingsacrihcedenougb,ifnottoomucb,totbe
pbi|osopbica|demoninatbesisinmedicine.Andso| de|iberate|y
gavemyconc|usions tbeappearance ofpropositionswbicbwere
simp|yandmoderate|ymetbodo|ogica|.
3
2
I ntroduction
Tbe problem of patbological structures andbebaviors in man is
enormous.Acongenitalclubfoot,asexualinversion,adiabetic,a
scbizopbrenic,pose innumerable questions wbicb,intbeend,refer
to tbe wbole of anatomical, embryological, pbysiological and
psycbologicalresearcb. | tisnevertbeless ouropinion tbattbis
problemmustnotbebrokenupandtbattbecbancesforclarifying
itaregreaterifitisconsidereden bloc tbanifitisbrokendown
intoquestionsofdetail. butfortbemomentweareinnoposition
tomaintaintbisopinionbypresentingasufb cientlydocume
ted
syntbesis,wbicbwedobopetoworkoutoneday. Uowever,tbis
publicationofsomeofourresearcbexpressesnotonlytbispresent
impossibilitybutalso tbe intention tomarksuccessive pbases in
tbe inquiry.
|bilosopbyisa redectionforwbicballunknownmaterialis
good,andwewouldgladlysay,forwbicballgoodmaterialmust
beunknown. Uavingtakenupmedicalstudiessomeyears after
tbe endof our pbilosopbicalstudies, andparallel to teacbing
pbilosopby, weowesomeexplanationofourintentions. |tisnot
necessarilyinordertobebetteracquaintedwitbmentalillnesses
tbataprofessorofpbilosopbycanbecomeinterestedinmedicine.
Norisitnecessarilyinordertoexerciseascientihcdiscipline.We
3 3
expectedmedicinetoprovidepreciselyanintroductiontoconcrete
bumanproblems. Vedicine seemedtousandstill seemstouslike
atecbniqueorartattbecrossroadsofseveralsciences,ratbertban,
strictlyspeaking, like onescience. |t seemedto ustbat tbetwo
problemswbicbconcemedus,tbatoftberelationsbetweenscience
andtecbnology, andtbatofnormsandtbe normal, badtoprobt
froma directmedical educationfor tbeirprecisepositionand
claribcation. |napplyingtomedicineaspiritwbicbwewouldlike
tobeabletocall'unprejudiced, itseemedtoustbat,despiteso
manylaudableeffortstointroducemetbodsofscientihcrationali-
zation,tbeessentiallayintbeclinicandtberapeutics,tbatis,ina
tecbnique of establisbingorrestor|ng tbe normal wbicbcannot
bereducedentirelyandsimplytoa singleform of know|edge.
Tbe present work is tbus an elIort to integrate some of tbe
metbodsandattainmentsofmedicineintopbilosopbicalspecula-
tion. |tisnecessarytostatetbatitisnotaquestionofteacbinga
lesson,orofbringinganormative|udgmenttobearuponmedical
activity. Weare not so presumptuous as topretendtorenovate
medicinebyincorporatingametapbysicsintoit. |fmedicineisto
berenovate, itisuptopbysicians to do soattbeirriskandto
tbeircredit.butwewanttocontributetotberenewalofcertain
metbodologicalconceptsbyadjustingtbeircomprebensiontbrougb
contactwitbmedicalinformation.Vaynooneexpectmorefrom
ustbanwewantedtogive.Vedicineisveryoftenpreyandvictim
to certain pseudo-pbilosopbicalliterature, notalways unnown,
itmustbesaid,todoctors,inwbicbmedicineandpbilosopbyrarely
come out well. |t is not our intentionto bring gristto tbe mill.
Nor do we intendtobebave as anbistorianof medicine. |f we
baveplacedaprobleminbistoricalperspectiveintbenrstpartof
ourbook, itisonlyforreasonsofgreaterintelligibility. Weclaim
no erudition in biograpby.
Aword on tbeboundaries of oursubj ect. !romtbemedical
34
INTRODUCTION TO SECTION ONE
pointofview, tbegeneralproblemof tbe normal and tbepatbo-
logicalcanbedehnedasateratologicalproblemandanosological
problemandtbislast,initstum,asaproblemofsomaticnosology
orpatbologicalpbysiology, andasaproblemofpsycbicnosology
orpatbologicalpsycbology. |n tbepresentexpositionewantto
limit ourselves verystrictly totbe problem of somatic nosology
orpatbological pbysiology, witbout, bowever, refrainingfrom
borrowingfromteratologyorpatbologicalpsycbologytbisdatum,
tbatnotionorsolution,wbicbwouldseemtousparticularlysuited
to clarify tbe investigation orconhrm some result.
Webavealsotriedtosetfortbourconceptionsinconnection
witbtbecriticalexaminationofatbesis,generallyadoptedintbe
nineteentbcentury, concerningtberelationsbetweentbenormal
andtbepatbological.Tbisistbetbesisaccordingtowbicbpatbo-
logicalpbenomenaareidenticaltocorrespondingnormalpbeno-
menasaveforquantitativevariations. Witbtbisprocedureweare
yieldingto a demandof pbilosopbicaltbougbtto reopen ratber
tbancloseproblems.Lonbrunscbvicgsaidofpbilosopbytbatit
istbescienceofsolvedproblems.Wearemakingtbis simpleand
profounddehnitionourown.
PART ONE
Is the Pathological State Merel
y
a
Quantitative Modification of the
Normal State?
CHAPTER |
Introduction to
the Problem
Toact, itisnecessaryatleasttolocalize. !orexample,bowdowe
takeactionagainstaneartbquakeorburricane?Tbeimpetusbebind
every ontological tbeoryof diseaseundoubtedlyderives from
tberapeuticneed. Wbenweseeineverysickmansomeonewbose
beingbasbeenaugmentedordiminisbed,wearesomewbatre-
assured,forwbatamanbaslostcanberestoredtobim,andwbat
basenteredbimcan also leave.We can bope toconquerdisease
evenifitistberesultofaspell,ormagic,orpossession,webave
onlytoremembertbatdiseasebappenstomaninordernottolose
allbope.Vagicbringstodrugsandincantationritesinnumerable
resources forgenerating a profoundly intense desire for cure.
>igeristbasnotedtbatLgyptianmedicineprobablyuniversalized
tbeLasternexperienceofparasiticdiseasesbycombiningitwitb
tbeidea of disease-possession.tbrowingupwormsmeansbeing
restoredtobealtb[ 1 07, i 20].
'
Lisease enters andleavesmanas
tbrougb a door.
A vulgarbierarcbyof diseases still exists today, based ontbe
extenttowbicbsymptomscan orcannot bereadilylocalized,
bence|arkinson'sdiseaseismoreofadiseasetbantbor+cicsbingles,
wbicbis,inturn,moresotbanboils. Witboutwisbingtodetract
fromtbegrandeurof|asteur'stenets,wecansaywitboutbesitation
39
tbattbegermtbeoryofcontagiousdiseasebascertainlyowedmucb
ofitssuccesstotbefacttbatitembodiesanontologicalrepresen-
tationofsickness.Aerall,agermcanbeseen,eveni tbisrequires
tbe complicatedmediationofamicroscope,stainsandcultures,
wbilewewouldneverbeabletoseeamiasmaoranind uence.To
seean entityisalreadyto foreseean action. No onewillobjectto
tbeoptimisticcbaracteroftbetbeoriesofinfectioninsofarastbeir
tberapeuticapplicationisconcerned. buttbediscoveryoftoxins
andtberecognitionoftbespecihcandindividualpatbogenicrole
of terrains bave destroyed tbe beautiful simplicity of a doctrine
wbose scientihc veneer for a long time bid tbe persistence of a
reaction to di sease as old as man bimself. !or terrain , see
glossary Tr. ]
| fwefeel tbe needtoreassure ourselves, itisbecause one
anguisb constantlybauntsourtbougbts, ifwe delegate tbe task
ofrestoringtbediseasedorganismtotbedesirednormtotecbnical
means,eitbermagicalormatteroffact[positive] itisbecausewe
expectnotbing goodfrom nature itself
bycontrast reekmedicine,intbeUippocraticwritingsand
'
practices,offersaconceptionofdiseasewbicbisnolongeronto-
logical,butdynamic,nolongerlocalizationist,buttotalizing.Nature
(physis), witbinmanaswellaswitbout,isbarmonyandequilibrium.
Tbe disturbance of tbis barmony, of tbis equilibrium, is called
disease.|ntbiscase,diseaseisnotsomewbereinman,itisevery-
wbereinbim,itistbewboleman.Lxtemalcircumstancesaretbe
occasion but nottbe causes. Van's equilibriumconsists of four
bumors,wboselluidityisperfectlysuitedtosustainvariationsand
oscillationsandwbosequalitiesarepairedbyopposites(bot/cold,
wet/dry), tbe disturbance of tbese bumors causes disease. but
diseaseisnotsimplydisequilibriumordiscordance, i tis, and
perbapsmostimportant,aneortontbepartofnaturetoeffect
anewequilibriuminman.Liseaseisageneralizedreactiondesigned
INTRODUCTION TO THE PROBLEM
tobringaboutacure,tbeorganismdevelopsadiseaseinorderto
getwelberapymusthrsttolerateandi necessary,reinforcetbese
bedonicandspontaneouslytberapeuticreactions.Vedicaltecbnique
imitatesnaturalmedicinalaction(vi s medicatrix naturae). Toimitate
isnotmerelytocopyanappearance.buttomimicatendencyand
toextendanintimatemovement.Ofcourse,sucbaconceptionis
alsooptimistic,butberetbeoptimismconcemstbewayofnature
and nottbe effectof buman tecbnique.
Vedicaltbougbtbasneverstoppedalternatingbetweentbese
tworepresentationsofdisease,betweentbesetwokindsofopti-
mism,alwayshndingsomegoodreasonforoneortbeotberattitude
in a newly explainedpatbogenesis. Lehciency diseases and all
infectiousorparasiticdiseasesfavortbeontologicaltbeory, wbile
endocrinedisturbancesandalldiseasesbeginningwitbdys- support
tbedynamicorfunctionaltbeoUowever,tbesetwoconceptions
dobaveonepointincommon.indisease,orbetter,intbeexperi-
ence of being sick, botb envision a polemical situation. eitber a
battlebetweentbeorganismandaforeignsubstance,oranintemal
strugglebetweenopposingforces. Liseasediffersfroma state of
bealtb,tbepatbologicalfromtbenormal,asonequalitydiffersfrom
anotber,eitberbytbepresenceorabsenceofadehniteprinciple,
orbyanalterationof tbe total organism. Tbisbeterogeneity of
normal and patbological states persists today in tbe naturalist
conception,wbicbexpectslittlefrombumaneffortstorestoretbe
norm,andinwbicbnaturewillhndtbewaystowardcure.butit
proveddifhculttomaintaintbequalitativemodihcationseparating
tbe normal from tbe patbological ina conceptionwbicballows,
indeedexpects,mantobeabletocompelnatureandbenditto
bisnormativedesires.Wasn'titsaidrepeatedlyafterbacon'stime
tbatonegovemsnatureonlybyobeyingit?Togovemdiseasemeans
to become acquainted witb its relations witb tbe normal state,
wbicbtbelivingman lovinglife wantstoregain.Uencetb
tbeoreticalneed,butapastduetecbnique,toestablisbascientihc
patbologybylinkingittopbysiology. Tbomas>ydenbam( 1 624-
1 689) tbougbttbatinordertobelpa sickman, bissicknessbad
tobedelimitedanddetermined. Tbereare disease speciesj ustas
tbereare animal orplantspecies. Accordingto >ydenbam tbere
isanorderamongdiseasessimilartotberegularity|sidoreCeofhoy
>aint-Uilaire found among anomalies. |inel j ustihedall tbese
attempts atclassihcationof diseasenosology]byperfectingtbe
genreinbisNosographie philosophique ( 1 797), wbicbLaremberg
describedas more tbe workof a naturalist tbana clinician 29,
l 20l ].
Veanwbile, Vorgagni's( 1 682-1 77 1 ) creationofa systemof
patbologicalanatomymadeitpossibletolinktbelesionsofcertain
organs togroups of stablesymptoms, sucb tbat nosograpbical
classibcationfoundasubstratuminanatomicalanalysis. butj ust
astbefollowersofUarveyandUa|lerbreatbedlifeintoanatomy
byturningitintopbysiology, sopatbologybecameanaturalex-
tensiouofpbysiology. (>igeristprovidesamasterful summaryof
tbisevolutionofmedicalideas.see 1 07, ll/l 42. )Tbeendresult
of tbis evolutionary process istbeformation ofa tbeoryof tbe
relationsbetweentbe normalandtbepatbological, accordingto
wbicbtbepatbologicalpbenomenafoundinlivingorganismsare
notbingmoretbanquantitativevariations,greaterorlesseraccord-
ingtocorrespondingpbysiologicalpbenomena. >emantically, tbe
patbologicalisdesignatedasdepartinghomtbenormalnotsomucb
byQ- ordys- asbyhyper- orhypo- . Wbileretainingtbeontological
tbeory'ssootbingconhdenceintbepossibilityoftecbnicalconquest
ofdisease,tbisapproacbisfarhomconsideringbealtbandsiclness
asqualitativelyopposed,orasforcesj oinedinbattle.Tbeneedto
reestablisbcontinuityinordertogainmoreknowledgeformore
elIectiveactionissucbtbattbe conceptof diseasewouldhnally
vanisb.Tbeconvictiontbatonecanscientihcallyrestoretbenorm
is sucb tbat in tbe end it annuls tbe patbological. Lisease is no
longertbe objectofanguisbfortbe bealtbyman, itbasbecome
insteadtbe obj ectof studyfor tbe tbeoristof bealtb. |t is in
patbology,writlarge,tbatwecanunraveltbeteacbingsofbealtb,
ratberas |lato sougbt in tbe institutions of tbe>tatetbe larger
andmoreeasilyreadableequivalentoftbevirtuesandvicesoftbe
individual soul.
|ntbecourseoftbenineteentbcentury, tberealidentityofnormal
andpatbologicalvitalpbenomena, apparentlysodifferent,andgiven
opposingvaluesbybumanexperience,becameakindofscientih-
callyguaranteeddogma,wboseextensionintotberealmsofpbi-
losopbyandpsycbologyappearedtobedictatedbytbeautbority
biologistsandpbysiciansaccordedtoit.Tbisdogmawasexpounded
in!rance byAuguste Comte and Claudebernard, eacb working
underverydifferentcircumstancesandwitbverydifferentinten-
tions. |nComte'sdoctrinetbe dogma is basedonanideataken
(witbexplicitandrespectful tbanks)from broussais. |nClaude
bernard itis tbe conclusion drawn froman entirelifetime of
biologicalexperimentation,tbepracticeofwbicbismetbodically
codibedintbefamousIntroduction a l'etude de la medecine expei
mentale. |nComte'stbougbtinterestmovesfromtbepatbological
totbenormal,witbaviewtodeterminingspeculativelytbelaws
oftbenormal,foritisasasubstituteforbiologicalexperimenta-
tion oftenimpracticable,particularlyonman tbatdiseaseseems
wortbyof systematicstudy. Tbe identityof tbenormalandtbe
patbological isassertedas againinknowledge of tbe normal.
bernard'sinterestmovesfromtbenormaltotbepatbologicalwitb
a viewtowardrationalaction directedattbepatbological, for it
isastbefoundationofanempbaticallynon-empiricaltberapeutics
tbatknowledgeof disease issougbtbymeansofpbysiologyand
43
derivingfromit. Tbeidentityoftbenormal andtbepatbological
isassertedasagaininremedyingtbepatbological.!inally,inComte
tbeassertionof identity remainspurelyconceptual,wbileClaude
bernardtriestomaketbis identity precise ina quantitative, nu-
merical interpretation.
|n calling sucb a tbeory a dogma we do not mean at all to
disparageit,butratbertostressitsscopeandrepercussions.Nor
isitatallbycbancetbatwedecidedtolooktoComteandbenard
fortbetextstbatdetermineditsmeaning.Tbeinduenceoftbese
two writersonnineteentb-centurypbilosopbyand science, and
perbapsevenmoreonliterature,isconsiderable. |tiswellestab-
lisbedtbatpbysiciansaremorewillingtolookfortbepbilosopby
oftbeirartinliteraturetbaninmedicineorpbilosopbytbemselves.
ReadingLittr,RenanandTainebascertainlyinspiredmoremedical
careers tban reading Ricberand orTrousseau. itis a factto be
reckonedwitb tbat peoplegenerally entermedicinecompletely
ignorantofmedicaltbeories,butnotwitboutpreconceivednotions
aboutmanymedicalconcepts.TbedisseminationofComte'sideas
in medical, scientihc andliterary circles was tbe workof Littr
and Cbarles Robin, hrst incumbent of tbe cbair of bistology at
tbe!acultyofVedicinein|aris. Tbeirinduenceisfeltmostof
all intbe heldof psycbology. !romRenanwe learn.
|nstudyingtbepsycbologyoftbeindividual,sleep,madness,
delirium,somnambulism,ballucinationofferafarmorefavorable
beldofexperiencetban tbenormal state. |benomena,wbicb
intbenormalstatearealmosteffacedbecauseof tbeirtenu-
ousness,appearmorepalpableinextraordinarycrisesbecause
tbeyareexaggerated.Tbepbysicistdoesnotstudygalvanism
intbeweakquantitiesfoundinnature,butincreasesit,bymeans
ofexperimentation, inordertostudyitmoreeasily, altbougb
tbelawsstudiedintbatexaggeratedstateareidenticaltotbose
4
of tbe natural state. >imilarlybuman psycbologywill baveto
beconstructedbystudyingtbemadnessofmankind,tbedreams
andballucinationstobefoundoneverypageoftbebistoryof
tbe buman spirit[99, 1 84].
L. Lugas, inbisstudyofRibot, clearlysbowedtberelationsbip
betweenRibot'smetbodologicalviewsandtbeideasofComteand
Renan, bis friendandprotector[37, 2| and 68]:
|bysiologyandpatbology,botbpbysicalandpsycbological,do
notstandincontrasttoeacbotberastwoopposites,butratber
astwopartsoftbesamewbole. . . . Tbepatbologicalmetbod
tendssimultaneouslytowardpureobservationandexperimen-
tation. |tisapowerfulmeansofinvestigationwbicbbasbeen
ricbinresults.Liseaseis,ineffect,anexperimentoftbemost
subtleorder,institutedbynatureitselfinveryprecisecircum-
stancesbymeansunavailabletobumanskill.naturereacbestbe
inaccessible[ 1 00].
Claudebernard'sinlluenceonpbysiciansbetween1 870 and1 9 1 4
i s equallybroadanddeep,botbdirectlytbrougbpbysiologyand
indirectlytbrougbliterature,asestablisbedbytbeworksofLamy
andLonald-kingontberelationsbetweenliterarynaturalismand
nineteentb-centurybiologicalandmedicaldoctrines[68 and34].
NietzscbeborrowedfromClaudebernardpreciselytbeideatbat
tbepatbologicalisbomogeneouswitbtbenormal.Quotingalong
passage on bealtb and sickness taken from Lecons sur la chaleur
animale (LecturesonAnimalUeat), Nietzscbe precedes itwitb
tbe following statement.
|tistbevalueofallmorbidstatestbattbeysbowusundera
magni(ingglass certain states tbatarenormal butnoteasily
visiblewben normal.
4S
Tbesesummaryindicationsmustsufhcetosbowtbattbetbesis
wbosemeaning and importance we are trying to dehne bas not
beeninventedfortbesakeoftbecause.Tbebistoryofideascannot
besuperimposedperforceon
tbebistoryofscience.butasscientists
leadtbeirlives asmeninanenvironmentandsocial setting tbat
isnotexclusivelyscientihc,tbebistoryof sciencecannotneglect
tbebistoryofideas. |nfollowingatbesistoitslogicalconclusion,
itcouldbesaidtbattbemodihcationsitundergoesinitscultural
milieu can reveal its essentialmeaning.
We cbosetocenterourexpositionaroundComteandClaude
bemardbecausetbesewritersreallyplayedtberole,balfvoluntarily,
of standardbearer,bencetbepreferencegiventbemoverso many
otbers,wboarecitedtoanequalextentandwbocouldbavebeen
more vividly explainedfrom one oranotberpointof view. !or
preciselytbe oppositereason,we decidedto add tbe exposition
of Lericbe's ideas to tbatof Comte's andbernard's. Lericbe is
discussedasmucbinmedicineasinpbysiology nottbeleastof
bismerits. butitispossibletbatanexaminationofbisideasfrom
anbistoricalperspectivewillrevealunsuspecteddeptbandsignih-
cance.Witboutsuccumbingtoacultofautbority,wecannotdeny
aneminentpractitioneracompetenceinpatbologyexcellingtbat
of ComteandClaudebernard.Voreover,asfar astbeproblems
examinedbereareconcemed,itisnotwitboutinteresttbatLericbe
presentlyoccupiestbecbairofmedicineattbeCollgede!rance
made famous by Claude bernardbimself. Tbus, tbe dilIerences
betweentbemare onlytbemoremeaningful andvaluable.
Cn- e+r s 1 1
Augus te Comte and
" Brous sais ' s Principle "
AugusteComteassertedtberealidentityofpatbologicalpbenom-
enaandtbecorrespondingpbysiologicalpbenomenaattbreeprin-
cipal stages of bis intellectual development. hrst, intbeperiod
leadinguptotbeeours de philosophie positive, cbaracterized,attbe
beginning,bybisfriendsbipwitb>aint->imon,witbwbombesev-
eredrelationsin l z+, `second,tbeactualperiodoftbepositive
pbilosopby,andtbird,tbeperiodoftbeSysteme de politique posi
tive, wbicb,incertainrespects,isverydifferentfromtbepreceding
one. Comtegavewbatbecalledbroussais'sprincipleuniversalsig-
nihcanceintbeorderofbiological,psycbologicalandsociological
pbenomena.
|twas in l ztbatComtetooknoticeof broussais's treatise
De l 'irritation et de la folie On|rritationandVadness]andadopted
tbeprincipleforbisownuse. Comtecreditsbroussais,ratbertban
bicbat, andbefore bim, |inel, witb baving declared tbatall dis-
easesacknowledgedas sucbareonlysymptoms andtbatdistur-
bances of vitalfunctionscouldnottakeplace witbout lesions in
organs,orratber, tissues. butabove all, adds Comte, neverbe-
forebadanyoneconceivedtbefundamentalrelationbetweenpa-
tbologyandpbysiologyi nsodirectandsatisfyingamanner.
broussaisdescribedalldiseasesasconsistingessentiallyintbeex-
47
cessorlackofexcitationintbevarioustissuesaboveorbelowtbe
degreeestablisbedastbenorm. Tbus, diseasesaremerelytbeef-
fects of simple cbanges in intensity in tbe action of tbe stimu-
lants wbicb are indispensablefor maintainingbealtb.
!romtbenonComteraisedbroussais'snosologicalconception
to tbe level of ageneral axiom. |twouldnotbeexaggeratingto
saytbatbeaccordedittbesamedogmaticvalueas Newton's law
ord'Alembert'sprinciple. Certainlywbenbetriedtolinkbisfun-
damentalsociologicalprinciple, progressisnotbingbuttbede-
velopmentoforder, tosomeotbermoregeneralprinciplewbicb
couldverifyit,Comtebesitatedbetweenbroussais'sautborityand
d'Alembert's. Uereferssometimes to d'Alembert's reduction of
tbelawsoftbepropagationofmovementtotbelawsofequilib-
riumz, I, 4-0-4],sometimestobroussais'sapborism.Tbepos-
itivetbeoryof tbecbangeabilityof pbenomena
iscompletelyreducedtotbisuniversalprincipleandresultshom
tbesystematicapplicationofbroussais'sgreatapborism. every
modihcation wbetbernaturalorartihcial of tbe real order
concerns onlytbeintensityoftbecorrespondingpbenomena
. . . ,despitevariationsindegree, pbenomenaalwaysretaintbe
same arrangement,everycbange intbeactualnature, tbatis,
class,of anobjectisrecognizedmoreoverasbeingcontradic-
tory z, III, 7 l ].
Littlebylittle Comtepracticallyclaimedtbeintellectualpaternity
oftbisprincipleforbimselfbyvirtueof tbefacttbatbeapplied
itsystematically,exactlyasbeathrsttbougbtthatbroussais,bav-
ingborrowedtbeprinciplefrom brown, was able to claim itfor
bimselfbecauseof tbe personalusebebadmadeof it z, IV App.
223]. Uere wemustquotearatberlongpassagewbicbwouldbe
weakened if summarized.
AUGUSTE COMTE AND "BROUSSAI S' S PRINCI PLE"
|n tbe case oflivingbeings,tbejudiciousobservationofdis-
easefonnsaseriesofindirectexperimentswbicbismucbmore
suitable tban most direct experiments to tbrow ligbt on ex-
plainingdynamicand even statisticalnotions.Vypbilosopbi-
calTreatisedidmucbtocommendtbenatureandscopeofsucb
aprocedurewbicbleadstotrulyimportantgainsinbiology. | t
rests on tbegreat principle, wbose discovery | attribute to
broussaisasitderivesfromtbesumtotalofbisworks,altbougb
| alone constructed tbe general anddirectformula. Until
broussais,tbepatbological state obeyedlaws completelydif-
ferentfrom tbose governingtbenonnalstate,sotbattbeex-
plorationof one could bave noelIectontbeotber. broussais
establisbedtbattbepbenomenaofdiseasecoincidedessentially
witbtbose of bealtbfrom wbicb tbeydifferedonlyin ters
ofintensity. Tbisbrilliantprinciplebasecometbebasisofpa-
tbology,tbussubordinatedtotbewboleofbiology. Appliedin
tbeoppositesenseitexplainsandimprovestbegreatcapacity
ofpatbologicalanalysisfortbrowingligbtonbiologicalspecu-
lations. . . . Tbeinsigbtsalreadygainedfrom itcanonlygivea
faintidea of its ultimateefhcacy. Tbose engagedintbeency-
clopedictaskofcompilingandclassifyingknowledgewillex-
tend broussais'sprincipleprimarily tomoral andintellectual
activitieswbere itbas notyetreceivedawortby application,
bence tbeir diseases surprise ormove uswitboutinstructing
us. . . . |ntbegeneralsystemofpositiveeducation,besidesits
directusefulnessforbiologicalproblems,tbisprinciplewillbe
anappropriatelogicalpreparationforanalogousproceduresin
anyscience.Tbecollectiveorganism,becauseofitsgreaterde-
greeofcomplexity, basproblemsmoreserious,varied,andfre-
quenttbantboseoftbeindividualorganism.|donotbesitate
tostatetbatbroussais'sprinciplemustbeextendedtotbispoint
and| bave oftenapplieditto conhnn orperfectsociological
49
laws. buttbeanalysisof revolutions could notilluminate tbe
positive study ofsocietywitbouttbe logical initiationresult-
ing,intbisrespect,fromtbesimplestcasespresentedbybiol-
ogy z, I, 6 l 3].
Ueretben isa principleof nosologyvestedwitbauniversal au-
tboritytbatembracestbepoliticalorder.Voreover,itgoeswitb-
outsayingtbatitistbislastproj ectedapplicationwbicbconfers
tbeprinciplewitballtbevalueofwbicbitisalreadycapable, ac-
cording to Comte, in tbe biological order.
Tbe fortietb lectureof tbe Cours de philosophie positive pbi-
losopbicalrellectionsontbewboleofbiology containsComte's
mostcompletetextontbeproblemnowbeforeus.|tisconcemed
witbsbowingtbedifhcultiesinberentintbesimpleextensionof
experimentalmetbods,wbicbbaveprovedtbeirusefulnessintbe
pbysicocbemicalspbere, to tbe particular cbaracteristics of tbe
living.
Anyexperimentwbateverisalwaysdesignedtouncovertbelaws
bywbicbeacbdeterminingormodifyinginlluenceof apbe-
nomenoneffects itsperformance, anditgenerallyconsistsin
introducingaclear-cutcbangeintoeacbdesignatedcondition
inordertomeasuredirectlytbecorrespondingvariationoftbe
pbenomenonitself z7, l 6-].
Now,inbiologytbevariationimposedononeorseveralofapbe-
nomenon's conditions of existence cannotberandom butmust
becontainedwitbincertainlimitscompatiblewitbtbepbenome-
non'sexistence.!urtbermore,ibefactofmnctionalconsensus proper
totbeorganismprecludesmonitoringtberelation, wbicblinksa
determineddisturbanceto its supposedlyexclusiveeffects, witb
sufhcientanalytical precision. but, tbinks Comte, if we readily
10
adittbattbeessenceofexperimentationliesnoti ntberesearcb-
er's artihcialinterventionintbe system ofapbenomenonwbich
beintentionallytendstodisturb,butratberintbecomparisonbe-
tweenacontrolpbenomenonandonealteredwitbrespecttoany
one of its conditions of existence, itfollows tbat diseases must
beabletofunctionfor tbescientistsasspontaneousexperiments
wbicballowacomparisontobemadebetweenanorganism'svari-
ous abnormal states andits normal state.
Accordingtotbeeminentlypbilosopbicalprinciplewbicbwill
servefrom now on as a direct,generalbasisfor positive pa-
tbologyandwbosedebnitiveestablisbmentweowetotbebold
andperseveringgeniusofourfamousfellowcitizen,broussais,
tbepatbologicalstateisnotatallradicallydifferentfromtbe
pbysiologicalstate,witbregardtowbicb nomatterbowone
looksatit itcanonlyconstituteasimpleextensiongoingmore
orless beyond tbe bigberorlowerlimitsof variationproper
to eacb pbenomenon of tbe normal organism, witbout ever
beingabletoproducereallynewpbenomenawbicbwouldbave
toacertaindegreeanypurelypbysiologicalanalogues z7,i /].
Consequently, every conception of patbologymustbebasedon
priorknowledgeoftbecorrespondingnormalstate,butconversely,
tbe scientihc study of patbological cases becomes anindispens-
ablepbaseintbeoverallsearcbfor tbelawsoftbenormalstate.
Tbeobservation of patbological cases offersnumerous,genuine
advantagesforactualexperimental investigation. Tbetransition
from tbenormalto tbeabnormalisslowerandmorenaturalin
tbecaseofillness, andtbereturntonormal,wbenittakesplace,
spontaneouslyfurnisbesaverifyingcounterproof. |naddition,as
farasmanisconcerned,patbologicalinvestigationismorefruit-
ful tban tbe necessarilylimitedexperimental exploration. Tbe
scientihcstudy ofmorbidstatesisessentiallyvalidforallorgan-
isms, evenplantlife, andisparticularlysuitedtotbemost com-
plexand,tberefore,tbemostdelicateandfragilepbenomenawbicb
directexperimentation, beingtoo brusquea disturbance, would
tendtodistort. UereComtewastbinkingofvitalpbenomenare-
latedtotbebigberanimalsandman,oftbenervousandpsycbic
functions. !inally, tbestudyofanomaliesandmonstrosities con-
ceivedasbotbolderandlesscurableillnessestbantbefunctional
disturbancesofvariousplantorneuromotorapparatusescompletes
tbe study of diseases . tbe 'teratologicalapproacbstudy of
monsters] is added to tbe patbological approacb in biological
investigation z1, i /-].
| tisappropriatetonote,hrst,tbeparticularlyabstractquality
oftbistbesisandtbeabsencetbrougboutofanypreciseexample
ofamedicalnaturetosuitablyillustratebisliteralexposition.>ince
we cannotrelate tbesegeneral propositions toany example, we
donotknowfromwbatvantagepointComtestatestbattbepatbo-
logicalbenomenonalwaysbasitsanalogueinapbysiologicalpbe-
nomenon, andtbatitisnotbingradicallynew. Uowisasclerotic
arteryanalogousto anormalone, oranasystolicbeart identical
to tbat of anatbleteattbebeigbtof bispowers? Undoubtedly,
wearemeanttounderstandtbattbe lawsofvitalpbenomenaare
tbesameforbotbdiseaseandbealtb.buttbenwbynotsaysoand
giveexamples?Andeventben,doestbisnotimplytbatanalogous
effectsaredeterminedinbealtbanddiseasebyanalogousmecba-
nisms?Wesbouldtbinkabouttbis examplegiven by >igerist.
Luringdigestion tbe number of wbite bloodcells increases.
Tbesameistrueattbeonsetofinfection. Consequentlytbis
pbenomenonissometimespbysiological,sometimespatbologi-
cal, depending onwbat causes it l 07, i 0-].
)2
>econdly, itsbouldbepointedout tbatdespitetbereciprocal
natureoftbeclarihcationacbievedtbrougbtbecomparisonoftbe
normalwitbtbe patbological andtbe assimilationof tbe patbo-
logicalandtbenormal,Comteinsistsrepeatedlyontbenecessity
of determiningtbe normal and its true limits of variation b rst,
beforemetbodicallyinvestigatingpatbologicalcases. >trictlyspeak-
ing, knowledge of normal pbenomena, based solely on observa-
tion,isbotbpossibleandnecessarywitboutknowledgeofdisease,
particularlybasedonexperimentation.butwearepresentedwitb
a seriousgap intbat Comte provides nocriterionwbicb would
allowus to knowwbata normal pbenomenon is. Weareleftto
concludetbatontbispointbeisreferringtotbeusualcorrespond-
ingconcept,giventbefacttbatbeusestbenotionsofnormalstate,
pbysiologicalstateandnaturalstateintercbangeably z7,i /, i /6].
betterstill,wbenitcomes to dehningtbelimitsof patbological
orexperimentaldisturbancescompatiblewitbtbeexistenceofor-
ganisms,Comteidentihestbeselimits witb tboseofabarmony
of distinctinlluences, tbose exterioras well as interior z7,
i 6-]- witbtberesulttbattbeconceptoftbenormalorpbysio-
logical, hnally clarihedbytbisconceptofharmony amounts to a
qualitativeandpolyvalentconcept,stillmoreaestbeticandmoral
tban scientib c.
Asfarastbeassertionofidentityoftbenormalpbenomenon
andtbecorrespondingpatbologicalpbenomenonisconcerned,it
is equally cleartbat Comte'sintentionistodenytbe qualitative
differencebetweentbesetwoadmittedbytbevitalists. Logically,
todenyaqualitativedierencemustleadtoassertingabomoge-
neity capable of expression in quantitative terms. Comte is un-
doubtedlybeadingtoward tbis wbenbe dehnes patbology as a
simpleextensiongoingmoreorlessbeyondtbebigberorlower
limitsofvariationproertoeacbpbenomenonoftbenormalor-
ganism. butintbeenditmustberecognizedtbattbetermsused
5
3
bere, altbougb onl
)
vaguel
)
and loosel
)
quantitative, stillbavea
qualitativeringtotbem. Comte tookfrombroussaistbisvocabu-
lapwbicbfailstoexpresswbatbewanted,andsoitistobroussais
tbatwereturninorderto understandtbeuncertaintiesandgaps
in Comte's exposition.
We prefertobaseoursummar
)
ofbroussais'stbeor
)
onbistrea-
tiseDe l'irritation et de la folie, since, of all bisworks, tbis istbe
oneComteknewbest. Webavebeenabletodeterminetbatnei-
tbertbe Traite de physio1oBie app1iquee a la patho1oBie Treatiseon
|bilosopb
)
Applied to |atbolog
)
]nortbeCatechisme de medecine
physio1oBique formulatestbistbeor
)
an
)
moreclearl
)
ordifferentl
broussais saw tbe vital primordial factin excitation. Van exists

onl
)
tbrougbtbeexcitationexercisedonbisorgansb
)
tbeenvi-
ronmentinwbicbbeiscompelledtolive.Tbrougbtbeirinnerva-
tionbotb tbe internal andexternalsurfacesof contacttransmit
tbisexcitationtotbebrain,wbicbsendsitbacktoalltbetissues
includingtbesurfacesofcontact.Tbesesurfacesareexposedto
twokindsofexcitation.foreignbodies andtbeind uenceof tbe
brain.| tisundertbecontinuousactionoftbesemultiplesources
ofexcitationtbatlifeissustained.Appl
)
ingtbepbysiologicaldoc-
trinetopatbolog
)
meanstr
)
ingtobndoutbow'tbisexcitation
can_deviatefromtbenormalstateandconstituteanabnormalor
diseasedstate l ,263]. Tbesedeviationsareeitberdehciencies
orexcesses. |rritationdilIersfromexcitationonl
)
intermsofde-
gre,itcanbedehnedastbeensembleofdisturbances'produced
intbeeconom
)
b
)
agentswbicbmakevitalpbenomenamoreor
lesspronouncedtbantbe
)
areintbenormalstate l ,26 /]. |r-
ritationistbus'normalexcitationtransformedb
)
itsexcess l ,
300].!orexample,tbrougblackofox
)
gen,aspb
)
xiadeprivestbe
lungs of its normal excitant. |nversel
)
, air witb toobigbanox
)
-
54
gen content 'overexcites tbe lungssomucbmore strongl
)
tbat
tbe organ ismore excitableandinllammationistberesult l ,
22]. Tbetwodeviations, brougbtaboutb
)
dehcienc
)
orexcess,
donotbavetbesameimportanceinpatbolog
)
,tbelatterconsid-
erabl
)
outweigbing tbe former. 'Tbis secondsourceof disease,
tbeexcessofexcitationconvertedintoirritationistbusmucbricber
tbantbehrst,tbelackofexcitation,anditcanbestatedtbatmost
ofourillsstemfromtbissecondsource l ,26]. |nusingtbem
intercbangeabl
)
, broussaisequatestbetermsabnormal, patholoBi
cal andmorbid l , 263, 2 /, 3 l ]. Tbe distinctionbetweentbe
normalorpb
)
siologicalandtbeabnormalorpatbologicalwould
tbenbeasimplequantitativeonelimitedtotbetermsofdebcienc
)
andexcess.Andoncebroussaisadmittedtbepb
)
siologicaltbeor
)
of tbeintellectualfaculties, tbis distinctionisvalidformentalas
well as organic pbenomena l , 440]. Tbis tben, insummar
)
, is
tbe tbesiswbosefortunecertainl
)
owesmore totbe personalit
)
of tbe autbor tban to tbe coberenceof bis text.
To begin witb, i nbis dehni tionof tbepatbological state,
broussais obviousl
)
confuses causeandeffect. A causecanvar
)
quantitativel
)
sotbatitnevertbelessbotbcontinuesandprovokes
qualitativel
)
differenteffects.Totakeasimple example,aquanti-
tativel
)
increasedexcitationcanbringaboutapleasantstate,soon
followedb
)
pain, twofeelingsnoonewouldwanttoconfuse.| n
sucbatbeor
)
twopointsofviewarebeingconstantl
)
mixedto-
getber,tbatof tbe sickmanwbo isexperiencingbis illnessand
wboistestedb
)
it,andtbatoftbescientistwbohndsnotbingin
diseasetbatcannotbeexplainedb
)
pb
)
siolog
)
. buttbestatesof
anorganismareliketbosefoundinmusic.tbelawsofacoustics
arenotbrokenincacopbon
)
tbisdoesnotmeantbatallcombi-
nations of sounds are agreeable.
|nsbort,sucbaconceptioncanbedevel
pedintwosligbtl
)
differentdirections,dependingonwbetbertberelationestablisbed
betweentbenormalandtbepatbologicalisoneofhomoaeneit or
continuit
)
. bgin,astrictl
)
obedientdisciple,adberesparticularl
)
to tbe relation of continuit
)
.
|atbolog
)
is no more tban a brancb, a result, a complement
ofpb
)
siolog
)
,orratber,pb
)
siolog
)
embracestbestud
)
ofvital
actionsatallstagesoftbeexistenceoflivingtbings.Witbout
noticing,wepassfrom oneto tbe otberof tbesesciences as
we examine functions from tbemoment tbe organsareper-
formingwitballtberegularit
)
anduniformit
)
ofwbicbtbe
)
arecapable,totbe pointwben tbelesionsaresoserioustbat
allmnctionsbecomeimpossibleandallmovementstops. |b
)
s-
iolog
)
andpatbolog
)
clarif
)
eacbotber 1,XVIII].
butitmustbesaidtbattbecontinuit
)
ofatransitionbetweenone
stateandanotbercancertainl
)
becompatiblewitbtbebeteroge-
neit
)
oftbesestates.Tbecontinuit
)
oftbemiddlestagesdoesnot
rule outtbe diversit
)
of tbe extremes. broussais's ownvocabu-
lar
)
sometimesbetra
)
sbisdifhcult
)
insustainingbisassertionof
arealbomogeneit
)
betweennormalandpatbologicalpbenomena,
forexample.'diseasesincrease,decrease,interrupt,corrupt 'tbein-
nervationoftbebrainintermsofitsinstinctive,intellectuaI,sen-
sitiveandmuscularrelations l , l l 4],and.'tbeirritationwbicb
developsinlivingtissuesdoesnotalwa
)
salter
8
tbeminamanner
tbatconstitutesindammation l , 30l ]. |n tbecaseof Comte,
tbevaguenessoftbenotionsofexcess anddiciency andtbeirim-
plicitqualitativeandnormativecbaracterisevenmorenoticeable,
scarcel
)
biddenundertbeirmetricalpretentions. Lxcessordeh-
cienc
)
existinrelationtoascaledeemedvalidandsuitable bence
inrelationtoanorm.Todebnetbeabnormalastoomucbortoo
littleistorecognizetbenormativecbaracteroftbeso-callednor-
malstate.Tbis normalorpb
)
siologicalstateisnolongersimpl
)
a
dispositionwbicbcanberevealedandexplainedasafact, buta
manifestationofanattacbmenttosomevalue.Wbenbgindehnes
tbe normal state as onewbere 'tbe organsfunctionwitball tbe
regularityanduniformityofwbicbtbeyarecapable, wecannot
fail torecognizetbat, despite broussais's borrorof all ontology,
an ideal of perfction soars over this attempt at a positive defnition.
!rombereononecanoutlinetbemajorobjectiontotbistbe-
sisaccordingtowbicbpatbologyisanextendedorbroadenedpbysi-
ology. Tbe ambitionto male patbology, andconsequentlytbera-
peutics,completelyscientib cbysimplymalingtbemderivefrom
apreviouslyestablisbedpbysiologywouldmalesenseonlyif,hrst,
tbe normal ould be debned in a purely objective way as a fact
andsecond,alltbedifferencesbetweentbenormalstateandtbe
patbologicalstatecouldbeexpressedinquantitativeterms,foronly
quantity can tale into account botb bomogeneity andvariation.
byquestioningtbisdoublepossibilitywedonotintendtounder-
value eitberpbysiologyorpatbology. Atanyrateitmustbeevi-
denttbatneitberbroussaisnorComtefulb lledtbetworequire-
mentswbicbseeminseparablefromtbeattemptwitbwbicbtbeir
names are associated.
Asfarasbroussaisisconcemedtbisfactisnotsurprising.Ve-
tbodicaltbinlingwasnotbisstrengtb.!orbimtbetbesesofpbysi-
ological medicine were valuable less as speculative anticipation
tojustifypainstalingresearcb,tbanasatberapeuticprescription,
intbeformofbloodletting,tobeimposedoneverytbingandev-
eryone.Armedwitbbislancetbeaimedespeciallyatindammation
foundin tbegeneral pbenomenon ofexcitationwbicbbadbeen
transformed by its excess intoirritation.As far asbis teacbings
are concerned, tbeirincoberencemust beattributedto tbefact
tbattbeyembody,witbouttoomucbcarefortbeirrespectiveim-
plications,tbeteacbingsofXavierbicbatand]obnbrown,about
wbomitwouldbeappropriate to saya few words.
5
7
!irst astudent, tben a rival ofCullen( l 7 l zl 70),tbe>cottisb
pbysician]obnbrown( l 71l 7) badlearnedfrombisteacber
abouttbenotionofirritabilitysuggestedbyClisson( l 96l 677)
anddevelopedbyUa|ler.Autboroftbebrstgreattreatiseonpbysi-
ology(Elementa physioloBiae, l 7 l 766), Ua|ler, a universaland
giftedspirit,understoodirritabilitytobetbetendencyofcertain
organs,particularlytbemuscles, torespondtoanystimuluswitb
acontraction.Contractionisnotamecbanicalpbenomenonanal-
ogousto elasticity, it istbe specihc responseofmusculartissue
todifferentexternalstimuli[sollicitations]. bytbesametoken,sen-
sibilityistbespecihcpropertyofnervoustissue[z9, //; l 1 his, //;
l 07, i , l l 0].
Accordingtobrown,lifeissustainedbymeansofonepartic-
ularpropertyalone,excitability,wbicballowslivingorganismsto
beaffectedandtoreact. |ntbeformofeitbersthenia orasthenia,
diseases are simplya quantitative modihcation of tbisproperty
wberevertbeexcitation iseitbertoostrongortoo weak. "
|t bas been proved tbat bealtband diseasearetbe same state
dependingupontbesame cause, tbat is, excitement, varying
only in degree, and tbat tbe powers producing botb are tbe
same,sometimesactingwitbaproperdegreeofforce,atotber
times eitberwitbtoomucbortoo little, tbat tbe wbole and
soleprovinceof apbysician,isnottolookformorbidstates
andremedieswbicbbavenoexistence,buttoconsidertbede-
viationof excitementfromtbebealtbystandard,inorderto
removeitbytbe propermeans (pp. 779).
Lismissingbotbtbesolidistsandtbebumorists,brownasserted
tbatdiseasedependsnotontbeprimitivedawofsolidsorlluids,
butsolelyontbevariationsoftbeintensityoftbeexcitation.Treat-
ingdiseasesmeansadjustingtbeamountofexcitationtoagreater
5
8
AUGUSTE COMTE AND " BROUSSAI S' S PRINCI PLE"
orlesserdegree. Cbarles Larembergsummarized tbese ideas in
tbefollowingwa
)
.
browntookforbisownandadaptedtobisowns
)
stemaprop-
osition | bave called to
)
ourattention several times in tbese
lectures,namel
)
tbatpatbolog
)
isaprovinceofpb
)
siolog
)
,or
asbroussaissaid,ofpatbologicalpb
)
siolog
|nfact,brownas-
serts(6)tbatitbasbeenfull
)
proventbattbestateofbealtb
andtbatof diseasearenot dierent,fortbever
)
reason tbat
tbe forces wbicb produce ordestro
)
botb bave tbe same ac-
tion, be tries toprove it, forexample, b
)
comparing muscle
contractionandspasmsortetanus ( 7et seq. ; cf. l 16)z9,
ll32].
Witboutdoubtwbatisparticularl
)
interestingi nbrown'stbeor
)
,
as Laremberg notes repeatedl
)
, is tbat it is tbe pointof depar-
tureofbroussais'sideas,butevenmoreinterestingistbefacttbat
toa certaindegreeitbasavaguetendenc
)
toendupasapatbo-
logicalpbenomenon. brownclaimedtoevaluatenumericall
)
tbe
variabledispositionof tbe org
ans tobeexcited.
>uppose tbegreateraffection of a part (as tbe inllammation
oftbelungsinpetipneumon
)
,tbeinllammationoftbefootin
tbegout,tbeeffusionofwaterintoageneralorparticularcav-
it
)
indrops
)
)tobeas6,andtbelesseraffectionofever
)
otber
parttobe1,andtbenumberoftbepartslessaffectedtoamount
to l 000,tbenitwillfollow,tbattberatioofaffection,conhned
totbepart, totbeaffectionofalltberestoftbebod
)
,willbe
as 6 to 1000. Tbis estimate, orsometbingver
)
like to it, is
provedb
)
tbeeffectoftbeexcitingburtfulpowers,wbicbal-
wa
)
sactupontbewbolebod
)
,andb
)
tbatoftberemedies,
wbicbalwa
)
sremovetbeeectoftbeburtfulpowersfromtbe
59
THE NORMAL AND THE PATHOLOGI CAL
wbole body, ineverygeneral disease (pp. z1z+).
Tbereapeutics is basedon calculation.
>upposetbestbenicdiatbesismountedupto60intbe scale,
toreduceitto+0itisevident,tbattbez0degreesofsuper|luous
excitementmustbetakenoff, andtberefore,tbatremediesop-
eratingwitbastimulus,weakenougbtoproducetbateffect,
mustbeemployed. . . (pp. +1++ note).
Certainlywecanandsbouldsmileattbiscaricatureoftbematbe-
matizationofpatbologicalpbenomena,butonlyontbecondition
tbatweagreetbattbisdoctrinedoesmeetinfulltbedemandsof
itspostulatesandtbatitsconceptsarecompletelycoberent,some-
tbingtbat is not true in broussais.
betterstill, a disciple of brown,>amuelLyncb,intbe same
spiritconstructedascaleofdegreesofexcitation,averitabletber-
mometer of bealtb and disease, as Laremberg calledit, in tbe
form ofaproportionalTable annexedtotbevarious editions or
translationsoftbeElementa medicinae. Tbistablebastwoparallel
scalesfrom0to0goinginoppositedirectionssotbattbemaxi-
mumofexcitability(0)correspondsto'0ofexcitationandvice
versa.>tartingfromperfectbealtb(excitation = +0,excitability =
+0) and going in botb directions, tbe various degrees on tbe
scalecorrespondtodiseases,tbeircauses, induencesandtreatments.
!orexample,between60and70ontbeexcitationscalearefound
tbediseasesof stbenicdiatbesis,peripneumonia,brainfever, se-
veresmallpox,severemeasles,severeerysipelasandrbeumatism.
!ortbesetbetberapeuticindicationisasfollows.'| nordertoef-
fectacure,excitationmustbedecreased.Tbisisacbievedbyavoid-
ingoverly strong stimuli,admittingonlytbeweakestornegative
stimuli.Curesarebloodletting,purging,diet,innerpeace,cold,etc.
60
|tmustbesaidtbattbisdisintermentofanobsoletenosology
was not intended toamuse or to satisfy tbevain curiosity of a
scbolar. |nauniquewayitapproacbesaprecisestatementoftbe
profound sense of tbe tbesis now before us. Logicallyspeaking,
itisquitecorrecttbatanidentihcationofpbenomena,wbosequal-
itative differences are considered illusory, takes tbe form of a
quantihcation. Uere tbeformofmetricalidentib cationissimply
acaricature.butoftenacaricaturerevealstbeessenceofaform
better tban afaitbful copy. |t is true tbatbrown and Lyncbsuc-
ceededonlyinconstructingaconceptualbierarcbyofpatbologi-
calpbenomena,aqualitativedevicetomarktbestatebetweentbe
twoextremesofbealtband illness. Varkingisnotmeasuring,a
markceqn]isnot acardinalunit. but eventbeerrorisinstruc-
tive,itmost certainlyrevealstbetbeoreticalsignihcanceof one
attempt, aswellastbelimitsencounteredintbeobjectitselfon
wbicbtbeattemptwasmade.
1 0
*
|fweadmittbatbroussaiswasabletoleamhombrowntbat,some
quantitativevariationsapart,tbeassertionoftbeidentityofnor-
mal and patbological pbenomenalogicallymeans superimposing
asystemofmeasurementonresearcb,wbatbeleamedhombicbat
certainly counterbalanced tbatin|luence. |n bisRecherches sur la
vie et la mort Researcb on Life and Leatb] ( l 00), bicbat con-
traststbeobjectandmetbodsofpbysiologywitbtbeobjectand
metbodsofpbysics.Accordingtobim,instabilityandirregularity
aretbeessentialcbaracteristicsofvitalpbenomena,sucbtbatforc-
ingtbemintoarigidframeworkofmetricalrelationsdistortstbeir
nature l z,art . 7, I]. |t wasfrombicbattbat Comte andeven
Claudebernardtooktbeirsystematic distrustofanymatbemati-
caltreatmentofbiologicalfacts,particularlyanyresearcbdealing
witb averages and statistical calculations.
bicbat's bostilitytowardall metrical designs inbiologywas
6 1
paradoxically allied witb bis assertion tbat diseases must be ex-
plainedintermsoftbe debnitely quantitativevariations oftbeir
properties,witbtbetissueswbicbmakeuptbeorgansservingas
a scale.
Toanalysepreciselytbepropertiesof livingbodies, tosbow
tbat every pbysiological pbenomenon is, intbe bnal analysis,
relatedtotbesepropertiesconsideredintbeirnaturalstateand
tbateverypatbologicalpbenomenonderiveshomtbeirincrease,
decrease,oralteration,tbateverytberapeuticpbenomenonbas
asitsprincipletbereturntotbenaturaltypefromwbicbtbey
baddeviated,todeterminepreciselytbecaseswbereeacbone
comes into play. . . tbis istbegeneralideaof tbiswork l 1,
I, XIX].
Uere istbesource of tbatambiguity of i deas wbicb we bave
alreadycriticizedinbroussaisandComte.Augmentationanddim-
inutionare conceptswbicbconnotequantity, butalterationisa
conceptofqualitativeforce. Onecannot,ofcourse,blamepbysi-
ologistsandpbysiciansforfallingintotbattrapof tbe>ameand
tbeOtberintowbicbsomanypbilosopbersbavefallensince|lato.
butitisgoodtobeabletorecognizetbetrapandnotblitbelyig-
noreitj ustwbenoneiscaugb. AlI of broussais's teacbings are
containedinembryo intbis propositionof bicbat.
Allcurativeresourcesbaveonlyonegoal,toretumalteredvital
properties to tbeirnatural state. Allmeans wbicb failto di-
minisbtbe increased organic sensibilityinin|lammation, wbicb
donotincreasetbecompletelydiminisbedpropertyinedemas,
inhltration,etc.,wbicbdonotloweranimalcontractilityincon-
vulsions anddo notraiseitinparalysis, etc. , essentiallymiss
tbeirgoal, tbey are contra-indicated l 1, I, i 2].
62
Tbeonlydifferencei stbat broussais reducedallpatbogeny to a
pbenomenonof increaseandexcess and,consequently,alltberapy
tobloodletting. Uere itiscertainlytruetosaytbat excess inev-
erytbing isa defect'
|tmaybesurprisingtoseetbatanexpositionof Comte'stbeory
basturnedintoapretextforaretrospectivestudy. Wbywasn' ta
cbronological order employed attbe outset?becauseabistorical
narrativealwaysreversestbetrueorderofinterestandinquiry. | t
i si ntbepresenttbatproblemsprovokeredection.Andi fredection
leadstoaregression,tberegressionisnecessarilyrelatedtoit.Tbus
tbebistoricaloriginisreallylessimportanttbantberedectiveor-
igin. Certainlybicbat,tbefounderofbistology, owes notbingto
Comte. |t is not evencertain tbat tberesistanceencounteredby
tbe cellulartbeory in !rance is reallybroadlyrelatedto Cbarles
Robin'spositivistloyalties.|tisknowntbatComte,followingbicbat,
didnotadmittbatanalysis couldgobeyondtissues6+].Wbatis
certain inany case istbatevenintbemilieuof medical culture,
tbetbeoriesofgeneralpatbologyoriginatedbybicbat,brownand
broussaiswereinduentialonlytotbeextenttbatComtefoundtbem
advantageous.Tbepbysiciansoftbesecondbalfoftbenineteentb
centurywerefortbemostpartignorantof broussaisandbrown,
butfewwereunawareofComteorLittr,justastodaymostpbys-
iologistscannotignorebernard,butdisregardbicbattowbomber-
nardis connectedtbrougbVagendie.
bygoingbacktotbemoreremotesourcesofComte'sideas ~
tbrougb tbepatbologyofbroussais, brown andbicbat we put
ourselvesinabetterpositiontounderstandtbeirsignihcanceand
limits.Weknowtbatitwasfrombicbat(tbrougbtbeintermedi-
aryofbisteacberinpbysiology,deblainville)tbatComteacquired
adecidedbostilitytowardallmatbematizationofbiology. Ueac-
countsfortbisatgreatlengtbintbefortietblectureoftbeCours
de philosophie positive. Tbat in|luence of bicbat's vitalism on tbe
Comteanpositivistconceptionof vital pbenomena,boweverdis-
creet,balancestbeprofoundlogicalrequirementsoftbeassertion
oftbeidentitybetweenpbysiologicalandpatbologicalmecbanisms,
requirementsmoreoverignoredbybroussais,anotberintermedi-
arybetweenComteandbicbatononeprecisepointofpatbo|og-
ical doctrine.
OnemustbearinmindtbatComte's aimsandintentions are
verydifferenthombroussais's,orratber,differenthombroussais's
intellectualantecedents,wbenbedevelopstbesameconceptions
in patbology. Ontbe one band, Comte claims to be codifying
scientihcmetbods,ontbeotber,tobeestablisbingapoliticaldoc-
trinescientihcally. bystatinginageneralwaytbatdiseasesdonot
cbangevitalpbenomena,Comteisj ustibedinstatingtbattbecure
for politicalcrises consists inbringingsocietiesbacktotbeires-
sentialandpermanentstructure,andtoleratingprogressonlywitbin
limits of variation of tbe natural order dehned bysocial statics.
|npositivistdoctrine,broussais'sprincipleremainsanideasub-
ordinatedtoasystem,anditistbepbysicians,psycbologistsand
menofletters,positivistbyinspirationandtradition,wbodissem-
inateditas anindependentconception.
Cn- e+r s | | |
Claude Bern ard a nd
E x
p
erimental Patholo
gy
|t iscertain tbat Claude bernardneverreferredto Comte wbile
dealingwitbtbeproblemoftberelationsbipbetweentbenormal
andtbepatbological,altbougbbedidsolveitinanapparentlysim-
ilarfasbion,itisequallycertaintbatbecouldnotignoreComte's
opinions.WeknowtbatClaudebernardreadComteclosely,and
witb pen in band, as borne outby notes dating probablyfrom
l 666,andpublisbedin l 91by ]acquesCbevalier l l ]. !or
tbe pbysicians andbiologists of tbe >econd Lmpire, Vagendie,
ComteandClaudebernardaretbreegods ortbreedevils of
tbe same religion. |nexaminingtbe experimentalworkofber-
nard's teacber,Vagendie,Littranalyzestbosepostulateswbicb
coincide witb Comte's ideas onexperimentationinbiology and
itsrelationtotbeobservationofpatbologicalpbenomena7, i 62].
L. CleywastbehrsttosbowtbatClaudebernard, inbisarticle
|rogrs des sciences pbysiologiques (Revue des Deux Mondes, l
August l 6), tookforbis owntbelawof tbetbree states, and
tbatbebadapartinpublicationsandassociationsinwbicbCbarles
Robinmadetbepositivistin|luencefelt++, i 64i /0]. |n l6+,
togetberwitbbrown->quard, RobinpublisbedtbeJournal de
l 'anatomie et de la physiologie normales et pathologiques de l 'homme
et des animaux: reportsofbernard,Cbevreul,etc.appearedintbe
brst issues. bernard was tbe secondpresidentof tbe >ocit de
biologiewbicbRobinbadfoundedin l +, wboseguidingprin-
ciples were formulated in a lecture to tbe cbartermembers.
bystudyinganatomyandtbeclassib cationoflivingbeings,we
bopetoclarifytbemecbanismoffunctions,bystudyingpbys-
iology, tocometoknowboworganscanbecbangedandwitbin
wbatlimits functions deviate from tbe normal ++, i 66].
!orbispart,Lamybassbowntbat,inpractice,nineteentb-century
artistsandwriters,wbolookedforsour
esofinspirationortbemes
toredectuponinpbysiologyandmedicine,didnotdistinguisbbe-
tween tbe ideas of Comteandtboseof bernard6].
Uavingsaidtbat,wemustaddtbatitisreallyaverydifhcult
anddelicatetasktooutlineClaudebernard'sideasontbeprecise
problemof tbenatureandmeaningofpatbologicalpbenomena.
Uereisascientistofnotewbosediscoveriesandmetbodsstillbear
fruittoday, towbompbysiciansandbiologistsreferconstantly,and
forwboseworkstbereisnocompletecriticaledition'Vostoftbe
lecturesgivenattbeCollgede!rancewereeditedandpublisbed
bystudents.buttbatwbicbbernardbimselfdidwrite,biscorre-
spondence,basnotbeentbeobjectofanyfair,metbodicalinvestiga-
tion. Notesandnotebooksbavebeenpublisbedbereandtbereand
bave immediately becometbe centerofcontroversysoexpressly
tendentioustbatonewonderswbetbertbesameinsinuations,wbicb
aremoreoverquite varied, did not actuallyprovoketbepublica-
tionofalltbesefragments. bernard'stbougbtremainsaproblem.
Tbeonlybonestsolutionwillbetbesystematicpublicationofbis
papers and,wben tbis decision is hnally reacbed, tbeplacingof
bis papers inanarcbive.
' '
66
CLAUDE BERNARD AND EXPERIMENTAL PATHOLOGY
|n bernard's work, tberealidentity sbouldonesayinmecba-
nismsorsymptomsorbotb? andcontinuityofpatbologicalpbe-
nomenaandtbecorrespondingpbysiologicalpbenomenaaremore
a monotonous repetition tban a tbeme. Tbis assertion is to be
found in tbe Leons de physiologie experimentale appliquee d la
medecine Lectureson Lxperimental|bysiologyAppliedtoVedi-
cine]( l ),especiallyintbesecondandtwenty-secondlectures
of\ol. 11, andintbeLeqons sur la chaleur animale LecturesonAni-
malUeat]( l 76). WeprefertocboosetbeLeqons sur le diabete et
la glcogenese animale LecturesonLiabetesandAnimalClycogene-
sis]( l 77)astbebasictext,wbicb,ofallbernard'sworks,canbe
consideredtbe one especially devoted to illustrating tbe tbeory,
tbe onewbereclinicalandexperimentalfactsare presentedatleast
asmucbfortbe moral ofametbodologicalandpbilosopbical
orderwbicbcanbedrawnfrom it, as for tbeirintrinsicpbysio-
logicalmeaning.
bernardconsideredmedicineastbescienceofdiseases,pbys-
iology as tbe science of life. |n tbe sciences it is tbeory wbicb
illuminatesanddominatespractice.Rationaltberapeuticscanbe
sustainedonlybya scientihcpatbology, anda scientihcpatbol-
ogymustbebasedonpbysiologicalscience.Liabetesisonedis-
easewbicbposesproblemswbosesolutionprovestbepreceding
tbesis.
Commonsensesbowstbatifwearetborougblyacquaintedwitb
apbysiologicalpbenomenon,wesbouldbeinapositiontoac-
countforalltbedisturbancestowbicbitissusceptibleintbe
patbologicalstate.|bysiologyandpatbologyareintermingled
andare essentiallyoneandtbe same tbing9, 6].
Liabetesisadiseasewbicbconsistssolelyandentirelyintbedis-
orderof a normal function.
6
7
Lverydiseasebas a corresponding normal functionof wbicb
itisonlytbedisturbed,exaggerated,diminisbedorobliterated
expression. |f we are unable to explain allmanifestations of
diseasetoday,itisbecausepbysiologyisnotyetsufbcientlyad-
vancedandtberearestillmanynormalfunctionsunknownto
us9, 6].
|ntbisbernardwasopposedtomanypbysiologistsofbisday, ac-
cordingtowbomdiseasewasanextra-pbysiologicalentity, super-
lmposedontbeorganism.Tbestudyofdiabetesnolongerallowed
sucb an opinion.
|neffectdiabetesiscbaracterizedbytbefollowingsymptoms.
polyuria, polydipsia,polypbagia, autopbagia, andglycosuria.
>trictly speaking, none of tbese symptoms represents a new
pbenomenon,unknowntotbenormalstate,norisanyaspon-
taneousproductionofnature.Ontbecontraryalloftbempre-
exist, savefortbeirintensity wbicbvariesintbenormalstate
andintbe diseased state9, 666].
|tiseasytodemonstratetbisasfar aspolyuria,polydipsia,poly-
pbagiaandautopbagiaareconcerned,lesseasywitbregardtogly-
cosuria.butbernardcontendedtbatglycosuriaisa maskedand
unnoticedpbenomenonintbenormalstateandtbatonlyitsex-
aggerationmakesitapparent9, 6 /]. |n reality bernarddoesnot
effectivelyprovewbatbeispropounding.|ntbesixteentblecture,
aftercomparingtbeopinionsofpbysiologists,wboasserttbecon-
stantpresenceofsugarinnormalurine,witbtbatoftbosewbo
denyit,afterbavingsbowntbe difhcultyofexperimentsandof
tbeircontrol, bernardaddstbatintbenormalurineofananimal
fedonnitrogenizedsubstancesanddeprivedofsugarandstarcbes,
beneversucceededinuncoveringtbefaintesttracesofsugar,but
68
tbatitwouldbecompletely differentwitbananimalfedonex-
cessiveamountsofsugarandstarcbes. |tisequallynaturaltotbink,
be says, tbatintbe course of its oscillations,glycemia candeter-
mine tbe passage of sugar in tbe urine.
|nsum, | do notbelievetbat tbis propositioncanbe formu-
latedasanabsolute trutb. tbereissugarinnormal urine. but
| readilyadmittbattberearemany, manycaseswbere tbere
are traces, tbere isa kind of transientglycosuriawbicb bere
aseverywbereestablisbesanimperceptible andelusivepassage
between tbepbysiological andtbepatbologicalstates. | agree
inotberrespectswitbcliniciansinrecognizingtbattbeglycos-
uricpbenomenonbasnoreal,wellestablisbedpatbologcalcbar-
acteruntil it becomes permanent 9, 3-0].
| tisstrikingtodocumentberetbat,intryingtofurnisbapar-
ticularlyconvincingfactfavoringbisinterpretationinacasewbere
befeltespeciallycballenged, bernardfoundbimselfforcedtoadmit
tbis same fact witbout experimental proof byreason of tbe
tbeory bysupposingtbatitsrealitywassituatedbeyondtbelim-
its of sensibilityof all tbemetbodsusedat tbattimefor itsde-
tection.Today H. !rdricqadmitsontbisverypointtbattbere
isnonormalglycosuria,tbatincertaincaseswberealargeamount
of liquidisingestedandtbereiscopiousdiuresis,glucosecannot
bereabsorbedin tbe kidneyattbelevel of tbe convolutedtube
andis,sotospeak,wasbedaway+0, 33]. Tbisexplainswbycer-
tainwriters like Nolf can say tbat tbere is a normal inbnitesimal
glycosuria90,2 i ].|ftbereisnoglycosurianormally,wbatpbys-
iological pbenomenondoes diabeticglycosuriaexaggerate quan-
titatively?
briedy, we knowtbatClaudebernard'sgeniusliesintbefact
tbat be sbowedtbat tbesugarfoundin an animal organism is a
productoftbissameorganismandnotj ustsometbingintroduced
fromtbeplantworldtbrougbitsfeeding,tbatbloodnormallycon-
tains sugar, andtbaturinary sugar is a productgenerally elimi-
natedbytbekidneyswbentberateofglycemiareacbesacertain
tbresbold.|notberwords,glycemiaisaconstantpbenomenonin-
dependentoffoodintaketosucbanextenttbatitistbeabsence
ofbloodsugartbatisabnormal,andglycosuriaistbeconsequence
ofglycemiawbicbbasrisenaboveacertainquantity,servingasa
tbresbold. |n a diabetic,glycemia is not in itself a patbological
pbenomenon itissoonlyintermsofitsquantity,initself,gly-
cemiaisanormalandconstantpbenomenoninabealtbyorgan-
ism [9, i i ].
Tbereisonlyoneglycemia,itisconstant,permanent,botbdur-
ingdiabetesandoutsidetbatmorbidstate.Onlyitbasdegrees.
glycemiabelow1to+%doesnotleadtoglycosuria,butabove
tbatlevelglycosuriaresults. . . . |tisimpossibletoperceivetbe
transition from tbe normal to tbe patbological state, andno
problemsbowsbettertbandiabetestbeintimatemsionofpbysi-
ology and patbology9, i 32].
Tbeenergybernardspentexpoundingbistbesisdoesnotseem
super|luous if tbe tbesis is placed ina bistorical perspective. |n
l 66 ]accoud,professoraBleBe attbe!acultyofVedicinein|aris,
dealtwitbdiabetesina clinicallecturebysayingtbatglycemiais
aninconstant,patbological pbenomenonandtbattbeproduction
of sugarintbeliver is, accordingtotbeworkof |avy, a patbo-
logicalpbenomenon.
Tbediabeticstatecannotbeattributedtotbeoverintensihcation
ofapbysiologicaloperationwbicbdoesnotexist... . |tisim-
possibletoregarddiabetesastbeoverintensihcationofareg-
70
ularoperation.itistbeexpressionofanoperationcompletely
foreign to normal life. Tbis operation isinitself tbe essence
of tbe disease 7, 26].
| n l 1 , wben bernard's tbeorywasmore hrmlyestablisbed,
]accoud, bytbenprofessorof internal patbology, continuedto
maintainbisobjectionsinbisTaite de pathologie intere Treatise
on|nternal|atbology].Tbetransformationofglycogenintosugar
is eitbera patbological or cadaverous pbenomenon , -4].
|fwereallywanttounderstandtbemeaningandsignib cance
of tbe assertion of continuitybetweennormalandpatbological
pbenomena,wemustbearinmindtbattbe tbesistowardwbicb
bernard'scriticaldemonstrationsaredirectedisonewbicbadmits
aqualitativedifferencebetweentbemecbanismsandproductsof
tbevitalfunctionsoftbenormalstateandtboseoftbepatbolog-
icalstate.Tbiscontradictionoftbesisappearsperbapsmoreclearly
in tbeLeons sur la chaleur animale:
Uealtband diseaseare nottwo essentiallydilIerentmodes as
tbeancientpbysiciansbelievedandsomepractitionersstillbe-
lieve. Tbeysbouldnotbemadeinto distinct principles, enti-
tieswbicbhgbtovertbelivingorganismandmakeittbetbeater
of tbeircontest. Tbese are obsoletemedical ideas. |n reality,
betweentbesetwo modesof being,tbereare onlydifferences
ofdegree.exaggeration,disproportion,discordanceofnormal
pbenomenaconstitutetbediseasedstate.Tbereisnocasewbere
diseasewouldbaveproducednewconditions,acompletecbange
of scene, some new and special products , 3-i ].
Tosupporttbis bernardgives anexamplewbicb bebelievespar-
ticularlysuitedtoridiculetbeopinionbeishgbting.Aftertwo|tal-
ianpbysiologists,LussanaandAmbrossoli,repeatedbisexperiments
7 1
ontbecuttingoftbesympatbeticnerveandits effects, tbeyde-
niedtbepbysiologicalcbaracteroftbebeatengenderedbytbeva-
sodilatationoftbeeffectedorgans.Accordingto tbem,tbisbeat
wasmorbid,differentineveryrespectfrompbysiologicalbeat,tbe
latteroriginatingfromtbecombustionoffood,tbeformerfrom
tbecombustionoftissues. Asiffood,bernardreplied,were not
alwaysburnedattbeleveloftissuesofwbicbitbecomesaninte-
gralpart. Tbinkingtbatbebadeasilyrefutedtbe|talianwriters,
bernard added.
|nreality,pbysico-cbemicalmanifestationsdonotcbangeinna-
ture,wbetbertbeytakeplaceinsideoroutsidetbeorganism,
ina bealtbyordiseasedstate.Tbereisonlyone kindofcalo-

rihcagent,wbetberitisproducedinafurnaceorinanorgan-
ismitisnonetbelesstbesame. Tberecannotbepbysicalbeat
andanimalbeat,stillIess,morbidbeatandpbysiologicalbeat.
Vorbid animal beat and pbysiological beat dier onlyin de-
gree, not in tbeirnature[8, 394].
Uencetbeconclusion.
Tbeseideasofastrugglebetweentwoopposingagents,ofan-
tagonismbetweenlifeanddeatb,betweenbealtbandsickness,
inanimateandlivingnaturebavebadtbeirday.Tbecontinuity
ofpbenomena,tbeirimperceptiblegradationandbarmonymust
berecognized everywbere [ibid. ].
Tbeselasttwo textsseemtometobeparticularlyilluminat-
ingbecausetbeyrevealacbainofideasfoundnowbereintbeLeqons
sur le diabhe. !be idea oftbecontinuitybetweentbe normaland
tbepatbologicalisitselfincontinuitywitbtbeideaoftbeconti-
nuitybetweenlifeanddeatb,organicandinorganicmatter.ber-
7
2
nardbas tbeindisputable merit of baving denied tbeantitbesis
admitted until tbenbetweentbe organic andtbemineral,plant
andanimal,of bavingafhrmedtbeuniversalapplicabilityoftbe
deterministpostulate and tbe material identity of allpbysico-
cbemicalpbenomenaregardlessof tbeirsettingandappearance.
Uewas nottbehrsttoasserttbe identityoftbecbemicalprod-
uctsoftbelaboratoryandtboseof'livingcbemistry tbatidea
was conceivedafterWblersucceededinsyntbesizingurea in
l z besimply'reinforcedtbepbysiologicalimpulsegivenor-
ganiccbemistrybytbeworksofLumasandLiebig.
, ,
' butbewas
tbebrsttoasserttbepbysiological identityofplantfunctionsand
corresponding animal functions. Until bis time it was beld tbat
plant respiration was tbe inverse of tbatof animals, tbatplants
hxedcarbonandanimalsburnedit,tbatplantsperformedreduc-
tions and animals combustions, tbat plants producedsyntbeses
wbicbanimals destroyed by usingtbem, as tbeywereincapable
of producinganytbingsimilar.
bernarddeniedalloftbeseantitbeses,andtbediscoveryoftbe
glycogenicfunctionof tbeliveris one of tbe most beautiful re-
sults of tbe desire to 'recognize everywbere tbe continuity of
pbenomena.
Oneprobablydoesnotbavetoasknowwbetberbenardformed
acorrectidea of wbat constitutes an antitbesis orcontrast, and
wbetberitisj ustib able to considertbe pairofnotions, bealtb
diseaseassymmetricalwitbtbepairlifedeatb,todrawtbecon-
clusion tbat once be identibed tbe terms of tbe second, bewas
autborizedtoseektbeidentibcationoftbetermsoftbehrst.One
willprobablyaskwbatbernardmeantbyassertingtbeunityof
lifeanddeatb. !ortbepurposesoflayorreligiouspolemic,itis
ohenaskedwbetberbenardwasamaterialistoravitalist. ' |tseems
tbatacarefulreadingof tbe Lecons sur les phenomenes de la vie
Lectures ontbe |benomena ofLife]( l 7)suggestsananswer
7 3
fullofnuances.!romtbepbysicocbemicalpointofview,bernard
didnotaccepttbedistinctionbetweentbeorganicrealmandtbe
mineral realm. 'Tbecbemistryoftbelaboratoryandtbecbemis-
tryoflife are subjectto tbesamelaws. there are not two chemis
tries" [ 1 0, I, 224]. Tbisamountstosayingtbatscientib canalysis
andexperimentaltecbniquescanidentifyandreproduceproducts
ofvitalsyntbesesaswellasinorganicobjects. buttbissimplyas-
sertstbebomogeneityofmatterwitbintbelivingformandout-
sideoftbisform,forinrefusingmecbanisticmaterialism,bernard
assertstbeoriginalityoftbelivingformanditsfunctionalactivities.
Altbougbtbevitalmanifestationsareplacedundertbedirect
in|luenceofpbysico-cbemicalconditions,tbeseconditionscan-
notorganize,barmonizepbenomenaintbeorderandsucces-
sionwbicbtbeyassumeparticularlyinlivingtbings[ 1 0, I, 2 i ].
Andstillmore precisely.
AlongwitbLavoisier|believetbatlivingtbingsaretributaries
oftbegenerallawsofnatureandtbattbeirmanifestationsare
pbysicalandcbemicalexpressions. Unlikepbysicistsandcbem-
ists|amfarfromseeingvitalactionsintbepbenomenaoftbe
inanimate world ontbe contrary | believe tbat tbe expres-
sionisparticular,tbemecbanismspecial,tbeagentspecihcal-
tbougbtberesultistbesame.Nocbemicalpbenomenonexists
insidetbe bodyas itdoes outside of it[ibid. ].
Tbeselastwordscouldserveasanepigrapbfortbeworkof]acques
Luclaux ontbeAnalse physico-chimique des fonctions vitaJes [|by-
sico-cbemicalAnalysisof\ital!unctions].AccordingtoLuclaux,
wbo, in tbis work was obviouslyfar from anykindof spiritual-
ism,no intracellularcbemical reactioncanberepresentedby an
74
equation derivedfrom experimentationin vitro:
As soon as a body can be representedbyoursymbols, living
matterconsidersitanenemyandeliminatesorneutralizesit . . . .
Vanbascreatedacbemistrywbicbbasdevelopedfromnatu-
ralcbemistrywitbout being confused witb it[ 36].
betbatasitmay, itseemscleartbatforbernard,recognizing
tbecontinuityofpbenomenadoesnotmeanignoringtbeirorigi-
nality. Civen tbis, and keepingtbesymmetry, could one not say
wbatbe saysof tberelationsbetweeninanimateandlivingmat-
ter? tbereis onlyonepbysiology, butfar fromseeingtbetype
ofpatbologicalpbenomenainpbysiologicalpbenomena,onemust
considertbat its expression isparticular,itsmecbanism special,
altbougbtberesultisidentical,nopbenomenonexistsintbedis-
easedorganism as itdoes in tbebealtbyone. Wbyassert unre-
servedlytbeidentityofdiseaseandbealtbwbenonedoesnotdo
soforlifeanddeatb,wbenoneintendstousetberelationbetween
tbe latteras a modelfortbat between tbe former?
Claude bernard, unlikebroussaisand Comte, supportedbisgen-
eral principle of patbology witb veribable arguments, protocols
ofexperimentsandaboveallmetbodsforquantifyingpbysiolog-
ical concepts. Clycogenesis, glycemia,glycosuria, combustionof
food,beatfromvasodilatationarenotqualitativeconceptsbuttbe
summariesofresultsobtainedintermsofmeasurement. !rombere
onwe know exactly wbat is meant wben it is claimed tbat dis-
easeistbeexaggeratedordiminisbedexpressionofanormalfunc-
tion. Oratleastwebavetbemeanstoknowit,for inspite of
bernard'sundeniableprogressinlogicalprecision,bistbougbtis
notentirely freefrom ambiguity.
7
'
!irstofall,witbbenardaswitbbicbat,broussaisandComte,
tbere is a deceptive mingling of quanti tative and qualitative
conceptsintbegivendehnitionofpatbologicalpbenomena.>ome-
timestbepatbologicalstateistbedisturbanceofanormalmecb-
anism consisting in a quantitativevariation, an exaggeration or
attenuationofnormalpbenomena 9,360],sometimestbedis-
easedstateismadeupof tbeexaggeration,disproportion,dis-
cordanceofnormalpbenomena, 3-i ]. Wbodoesn'tseetbat
tbetermexaggerationbasadistinctlyquantitativesenseintbe
b rstdehnitionandaratberqualitativeoneintbesecond?Lidber-
nardbelieve tbatbe was eradicatingtbe qualitative valueof tbe
termpatbologicalbysubstitutingforittbetermsdis-turbance,
dis-proportion, dis-cordance?
Tbisambiguityiscertainlyinstructiveintbatitrevealstbattbe
problemitselfpersistsattbebeartoftbesolutionpresumablygiven
to it. Andtbeproblemistbefollowing.istbeconceptofdisease
aconceptofanobjectiverealityaccessibletoquantitativescientihc
knowledge?|s tbedifferenceinvalue, wbicbtbelivingbeinges-
tablisbesbetweenbisnormallifeandbispatbologicallife,anillu-
soryappearancewbicbtbescientistbastbelegitimateobligation
todeny?|ftbisannullingofaqualitativecontrastistbeoretically
possible, itis cleartbat itislegitimate, ifitisnotpossible, tbe
questionof its legitimacyissuper|luous.
|tbasbeenpointedouttbatbernardusestwoexpressionsin-
tercbangeably,quantitative variations anddiferences of de8ree, tbat
is,bemakestwoconceptsoftbem,hom08eneit andcontinuity, tbe
hrst usedimplicitly, tbe second, expressly Tbe useofeitberof
tbeseconceptsdoesnotentailtbesamelogicalrequirements.| f|
asserttbebomogeneityoftwoobjects,| must atleastdehne tbe
natureofoneoftbetwoorratbersomenature commontobotb.
butif|assertacontinuity, |canonlyinterpolatebetweentbetwo
extremesalltbeintermediariesatmydisposal,witboutreducing
oneto tbe otber, by divisions of progressivelysmaller intervals.
Tbisissotruetbatcertainwritersclaimcontinuitybetweenbealtb
anddiseaseinordertorefusetodehne eitberoftbem.' Tbeysay
tbattbereisnocompletelynormal state,no perfectbealtb. Tbis
canmeantbattbereexistonlysickmen. |nanamusingwayVolire
and ]ules Romainsbavesbownwbatkindofiatrocracycanjus-
tifytbisassertion.buttbiscouldalsomeantbattberearenosick
men,wbicbisnonetbelessabsurd. Onewonderswbetberpbysi-
cians, in stating seriouslytbat perfect bealtb does not existand
tbatconsequentlydiseasecannotbedehned,bave suspectedtbat
tbeywerepurelyandsimplyrevivingtbeproblemoftbeexistence
of tbeperfectand tbe ontological argument.
!oralongtimepeopletriedtobndoutwbetbertbeycouldprove
tbeexistenceoftbeperfectbeingstartingwitbitsqualityofperfec-
tion,since,bavingalltbeperfections,itwouldalsobavetbatofbring-
ingaboutitsownexistence.Tbeproblemoftbeactualexistenceof
perfectbealtbisanalogous. Asifperfectbealtbwerenotanorma-
tiveconcept,anidealtype?>trictly speakinganormdoesnotexist,
itplaysitsrolewbicbistodevalueexistencebyallowingitscorrec-
tion.Tosaytbatperfectbealtbdoesnotexistis simplysayingtbat
tbeconceptofbealtbisnotoneofanexistence,butofanormwbose
functionand value istobe brougbt into contact witb existence in
orderto stimulatemodihcation. Tbis does notmean tbat bealtbis
an empty concept.
butClaudeJernardisfar from sucbafacilerelativism,owing
totbe!acttbat brst, tbeassertionof continuityinbistbougbtal-
ways implies tbatof bomogeneity, andsecond, be tbinks tbat it is
always possibletogiveanexperimental content totbeconceptof
tbenormal. !orexample, wbatbecalls ananimal'snormalurine is
tbeurineofananimal witbanemptystomacb,alwayscomparable
to itself tbe animal feeding itself intbesamewaywitbits own
reserves and sucb tbatitserves as aconstantframeofreference
77
foralltbeurineobtainedintbefeedingconditionswbicbbewants
tosetup, II, i3]. Lateronwewilldiscusstberelationsbetween
tbe normal and tbe experimental. Rigbt now, we only want to
examinebemard'spointofviewwbenbeconceivesoftbepatbo-
logicalpbenomenonasaquantitativevariationoftbenormalpbe-
nomenon. Naturallyitisunderstoodtbatifintbecourseof tbis
examinationweuserecentpbysiologicalorclinicaldata,itisnotto
reproacbbernardforbaving ignored wbat be could not know.
|fglycosuriaisconsideredtobetbemajorsymptomofdiabetes,tbe
presenceof sugar in diabetic urine makes itqualitativelydifferent
fromnormal urine. |n terms oftbepbysiological state, tbepatbo-
logicalstate,wben identihedwitbitsprincipalsymptom,isanew
quality. butifinconsideringurineasaproductofrenalsecretion,
tbepbysician'stbougbttumstotbekidneyandtberelationsbipbe-
tweentberenalhlterandtbecompositionoftbeblood,bewillcon-
siderglycosuriaasexcessglycemiapouringoveratbresbold. Tbe
glucoseover|lowingtbetbresboldisqualitativelytbesameastbeglu-
cosenormallybeldbackbytbetbresbold.Tbeonlydifferenceis,in
effect,oneofquantity|f,tben,tberenalmecbanismofurinaryse-
cretionisconsideredin terms of itsresults pbysiological effects
ormorbidsymptoms diseaseistbeappearanceofanewquality,
iftbemecbanismisconsideredinitself,diseaseisonlyaquantita-
tivevariation. Likewise,alkaptonuriacouldbecitedasanexample
of anormalcbemicalmecbanismcapableofproducinganabnor-
malsymptom.Liscoveredbyboedekerinl7,tbisrarediseasecon-
sistsessentiallyinadisturbanceoftbemetabolismofanaminoacid,
tyrosine.Alkaptoneorbomogentisicacidisanormalproductoftbe
intermediatemetabolismoftyrosine,butalkaptonuricdiseasesare
distinguisbedbytbeirincapacitytogobeyondtbispbaseandburn
bomogentisicacid+l , i 0. 34].Uomogentisicacidtbenpassesinto
tbeurineandistransfonedintbepresenceofalkalistbrougboxi-
dationtogiveolIablackpigmentcoloringtbeurineandgivingita
newqualitywbicbisinnowayanexaggerationofsomequalitypres-
entinnonalurine.Voreover,alkaptonuriacanbebrougbtabout
experimentallybyamassiveabsorptionoftyrosine(50 gevery24
bours). Tbus, webaveapatbologicalpbenomenonwbicbcanbe
dehnedintensofqualityorquantitydependingonone'spointof
view,dependingonwbetbertbevitalpbenomenonisconsideredin
tens of itsexpressionoritsmecbanism.
butcanonecbooseone'spointofview?|sitnotobvioustbatif
wewanttoworkoutascientihcpatbologywemustconsiderreal
causesandnotapparenteffects,functionalmecbanismsandnottbeir
symptomaticexpressions?|sitnotobvioustbatbyrelatingglycos-
uriatoglycemiaandglycemiatobepaticglycogenesis,bernardwas
consideringtbemecbanisms,tbescientihcexplanationofwbicbde-
rivesfromanumberofquantitativerelations,forexample,tbepbysi-
cal lawsoftbeequilibriaofmembranes,tbelawoftbeconcentration
ofsolutions, tbe reactions oforganic cbemistry, etc. ?
Alloftbiswouldbeindisputableifpbysiologicalfunctionscould
beconsideredasmecbanisms,tbresboldsasbarriers,regulationsas
safetyvalves,servo-brakesortbennostats.Areweabouttofallinto
alltbetrapsanddangersoftbeiatro-mecbanistconceptions?Totake
tbesameexampleofdiabetes,todaywearefarfromtbinkingtbat
glycosuriaisonlyafunctionofglycemiaandtbattbekidneysimply
preventstbehltrationofglucosebymeansofaconstanttbresbold
(of1 . 70 ppbandnot3 ppbasbernardhrsttbougbt).Accordingto
CbabanierandLobo-Onell. 'Tberenaltbresboldisessentiallymo
bile, anditsbehavior, variable, dependingontbepatients[25, / 6]. On
tbeoneband,insubjectswitboutbyperglycemia,glycosuriacansome-
timesbedemonstrated,evenbigbertbantbatoftruediabetics.Tbis
isspokenofasrenalglycosuria.Ontbeotberband,insubjectswbose
glycemiasometimesreacbes3 gandmore,glycosuriacanbeprac-
79
ticallynil.Tbisiscalledpurebyperglycemia.!urtbermore,twodia-
betics situatedintbesame conditions for observationandsbowing
tbesameglycemiaof z. 0gintbemomingonanemptystomacb,
cansbowavariableglycosuria,onelosingz0gandtbeotber,200 g
of glucose intbeir urine z, i ].
Wearenowledtomodifytbeclassicscbeme,wbicblinkedgly-
cosuria to basal disturbance by tbe sole intermediary ofbypergly-
cemia,byintroducinganewarticulationbetweenbyperglycemiaand
glycosuria. "renal behavior" z, i -]. byspeakingoftbemobilityof
tbetbresbold,of renal bebavior, a notion is introducedintbeex-
planationoftbemecbanismofurinarysecretiontbatcannotbee
n-
tirelytranslatedintoanalyticalandquantitativeterms.Tbisamounts
tosayingtbattobecomeadiabeticistocbangekidneys,aproposi-
tionwbicbwillseemabsurdonlytotbosewboidentifyafunction
witbitsanatomical position. |tseemspermissibletoconcludetbat
bysubsutuungmecbanismsforsymptomsintbecomparisonbetween
tbepbysiologicalandtbepatbologicalstate,nodifferenceinquality
between tbe two states is eliminated at all.
Tbisconclusionloomslargerstillwbenwestopdividingdisease
intoamultiplicityof functionalmecbanismsgonewrong,andre-
garditasaneventinvolvingtbelivingorganismtakenasawbole.
Tbisisverymucbtbecaseofdiabetes.Todaywesayitisadiminu-
tionoftbeabilitytouseglucoseintermsofglycemiaz, i2].\on
VeringandVinkowski's discovery in 1 889 of experimental pancre
atic diabetes, Laguesse's discoveryof tbe endocrinepancreas, ban-
tingandbest'sisolationin1920 oftbeinsulinsecretedbytbeislands
ofLangerbans,madepossibletbeassertiontbattbemndamentaldis-
turbanceindiabetesisbypoinsulinemiadiabetesmellitus]. Vustit
besaidtbentbattbeseresearcbes,unsuspectedbybemard,hnally
conhrmedbisprinciplesofgeneralpatbology?Certainlynot,forin
1930-31 Uoussayandbiasottisbowed,bydestroyingbotbtbepan-
creasandtbepituitaryintbetoadanddog,tbattberolesoftbepi-
80
CLAU DE BERNARD AND EXPERIMENTAL PATHOLOGY
tuitaryandtbepancreaswereantagonisticinmetabolism.!ollowing
totalremovaloftbepancreasabealtbydogcannotsurviveformore
tbanfourorhveweeks. but acombinationofabypopbysectomy
removaloftbepituitary]andapancreatectomyproducesconsid-
erableimprovementindiabetes.glycosuriaisverymucbreducedand,
onanemptystomacb,evensuppressed,polyuriaissuppressed,gly-
cemiaisnearnormalandweigbtlossisverymucbsloweddown.
Uenceitseemedwarrantedtoconcludetbattbeactionofinsulin
intbemetabolismofglucidesisnotdirectsincediabetescanbeles-
senedwitbouttbeadministrationofinsulin.|n1 937 Youngestab-
lisbedtbatwitbaninjectionofanextractoftbeanteriorlobeof
tbepituitaryeverydayforabouttbreeweeks,anormaldogcould
sometimesbemadedeb nitelydiabetic.LouisUdonandAuguste
Loubatires,wbotookupYoung'sstudyofexperimentaldiabetes
in!rance,concluded."Temporar byperactivityoftbeanteriorlobe
oftbepituitarycanbeattbesourceofnotonlyatransitorydistur-
banceofglycoregulationbutalsopermanent diabetes wbicbpersists
indehnitelyaftertbedisappearanceoftbecausewbicbsetitoff
+,i0]. Uavewebeensentfromdiminutiontoaugmentation,and
isbernard'sinsigbt|lawlessj ustwbenwebelieveditatfault?|tdoes
notseemsobecause,alltbingsconsidered,tbispituitarybypersecre-
tionisonlyasymptom,attbeglandularlevel,ofeitberapituitary
tumororageneralendocrinalreadjustment(puberty,menopause,
pregnancy).Asfarasinternalsecretionsareconcemed,asintbecase
oftbenervoussystem,localizationsareprivilegedratbertbanab-
soluteandwbatappearstobepartialaugmentationordiminution
isinfactanalterationintbewbole.Notbingismoreillusory, writes
Ratbery,
tbanto considertbemetabolismofglucidesas undertbesole
controloftbepancreasanditssecretion.Tbemetabolismofglu-
cidesdependsonmanyfactors.(a)bloodvascularglands,(b)tbe
8 1
liver,(c)tbenervous system, (d) vitamins, (e)mineralelements,
etc.Nowanyoftbesefactorscancomeintoplaytobringabout
diabetes [98, 22].
|fweconsiderdiabetesasanutritionaldiseaseandconstantglyce-
miaasatonusindispensabletotbeexistenceoftbeorganismtaken
asawbole(>oula),' ` wearefarfrombeingabletodrawtbeconclu-
sionsaboutgeneralpatbologyhomtbestudyofdiabetestbatClaude
benard drew from it in 1 877.
Tbeseconclusionsaretobecriticizednotsomucbforbeingwrong
asfor beinginadequateandincomplete.Tbeystemhomtbeunwar-
rantedextrapolationofaperbapsprivilegedcase and,moreover,hom
adehnitionwbicbisclumsyintermsof tbepointofview adopted.
|tiscorrecttbatcertainsymptomsaretbequantitativelyvariedprod-
uctofconstantmecbanismsoftbe pbysiological state.Tbiswould
betbecase,forexample,witbbypercblorbydriaintbeulcerousstom-
acb. |tispossibleforsomemecbanismstobetbesameintbestate
ofbealtbandintbestateofdisease.|ntbecaseofastomacbulcer,
tbere|lexwbicbdeterminestbe secretionof gastricjuices always
seemstooriginatefromtbepyloriccavity,ifitistruetbattbeyare
stenosalulcersneartbepylorasaccompaniedbytbemostsignihcant
bypersecretionandiftberemovaloftbisregiontbrougbagastrec-
tomyisfollowed by a reduction of tbe secretion.
buthrstofall,asfarastbeprecisecaseofulcersisconcerned,
itmustbesaidtbattbeessenceoftbediseaseconsistsnotinbyper-
cblorbydria, but ratberintbefacttbatberetbestomacbisdigest-
ing itself, a state wbicb everyone will undoubtedlyagree diers
profoundlyfromtbe normal. |ncidentally, perbaps tbis wouldbea
goodexampletoexplainwbatanormalmnctionis.Afunctioncould
besaidtobenormalaslongasitisindependentoftbeeffectitpro-
duces.Tbestomacbisnormalaslongasitdigestswitboutdigesting
8 2
itse|f. Wbatistrueofbalancescalesisalsotrueofmnctions.hdelity
hrst, tben sensitivity.
!urtbennore,itmustbesaidtbattbereductionofallpatbologi-
cal cases totbeexplanatory scbeme proposedby bernard isvery
remote. Tbis is particularly true of tbe scbeme put forward in
tbeLerons sur la chaleur animale. Of course tbere isno normal
beatandpathologicalbeat,intbesensetbatbotbcanbeexpressed
interms of identical pbysical effects. tbedilatationof acolumn
of mercury in tbe course of takingarectaloraxillarytempera-
ture. but tbeidentityof tbe beat does not involve tbeidentity
of tbe source of beat nor even tbe identity of tbe mecbanism
for liberatingtbe calories. Claudebernardansweredbis | talian
adversaries by sayingtbatanimalbeatalways derivesfrom food
burnedat tbe tissue level. but tbe samefoodcanbeburned in
anynumberof ways,itsbreakdownstoppingat differentstages.
Topostulate,witbreason, tbe identityof cbemicalandpbysical
lawswitboneanotber, doesnotobligeonetoignore tbespecih-
cityoftbepbenomenawbicbrevealtbem. Wbenintbe course
of measurement of basal metabolism, a woman suering from
basedow'sorCraves's]diseasebreatbes into aclosedspacewbose
variationinvolumewillgivetberateofoxygenconsumption,oxy-
gen isalways bumed accordingto tbecbemicallaws of oxidation
( caloriesforoneliterof O
), and itispreciselybysettingup
tbeconstancy of tbese laws intbiscasetbatonecancalculate
tbevariationinmetabolismandtenitabnonnal. |tisintbispre-
cise sense tbattbere isan identityof tbepbysiologicaland tbe
patbological. but it could also be said tbat tbere is an identity
of tbecbemicalandtbe patbological. | twill beagreedtbattbis
isoneway tomaketbepatbological disappearandnot to clarify
it.|sn'ttbisalsotrueoftbe casewbereit is declaredbomogeneous
witb tbe pbysiological?
bywayofsummary, Claudebenard's tbeoryisvalidincertain
limited cases.
l. aslongas tbepatbological pbenomenon islimitedto some
symptom,leaving aside its clinical context (bypercblorbydria, byper-
tbermia or bypotbermia, re|lex byperexcitability),
z.aslongassymptomaticeffectsaretracedbacktopartial func-
tionalmecbanisms(glycosuriai termsofbyperglycemia,alkaptonuria
in terms of tbe incompletemetabolism of tyrosine).
Lvenwben limitedto tbeseprecise cases, bistbeoryrunsinto
manydifb culties. Wbowouldmaintaintbatbypertensionisasim-
pleincreaseintbepbysiologicalarterialpressureandneglecttbepro-
foundalterationintbestructureandmnctionoftbevitalorgans(beart
andbloodvessels,kidneys,lungs),analterationsucbtbatitconsti-
tutesanewwayoflifefortbeorganism,newbebaviorwbicbpru-
denttberapymusttakeintoaccountbynottreatingtbetensionat
anunropitiousmomentinordertobringitbacktotbenorm?Wbo
wouldmaintaintbatbypersensitivitytocertaintoxicsubstancesisa
simplequantitativemodihcationofanormalreactivity,witbouthrst
askingbimselfwbetbertbereisn'tonlytbeappearance(oftbefact
ofpoorrenaleliminationorofanoverlyrapidreabsorptioninre-
lationtoa generaldehnedstate),witboutsubsequentlydistinguisb-
ingisotoxicintolerancewberepbenomenaarecbangedonlyquan-
titatively,andbeterotoxicintolerance,wberenewsymptomsappear
inrelationtoa cbange of tbe cellularreactivitytotbe poison (A.
>cbwartz)? ' Tbesameistrueoffunctionalmecbanisms,wbicbcan
beeasilyexperimentedwitbseparately butin tbelivingorganism
allfunctionsareinterdependentandtbeirrbytbmsarecoordinated.
renalebaviorcanbeonlytbeoreticallydivorcedfromtbebebavior
of tbe organism functioning as a wbole.
ytakingexamplesoftbeorderofmetabolicpbenomena(dia-
betes,animalbeat),bernardfoundcaseswbicbweretoounilateral
tobegeneraloedwitboutsomearbitrariness.Uowcaninfectiousdis-
eases,wboseetiologyandpatbogenesisweretbenbeginningtoemerge
fromtbeirprescientihcborders,beexplainedwitbintbenamework
ofbis ideas?Certainlytbe tbeory ofinconspicuous[inapparent] in-
fections(CbarlesNicolle) ' 'andtbe tbeoryofterrain allowtbe as-
sertiontbatinfectiousdiseasepusbedrootsintotbeso-callednormal
state. but tbis widespreadopinionisnotunassailableforalltbat. |t
isnot normalforabealtbysubjecttobavedipbtberiabacillilodged
inbis tbroat, intbesamesensetbat itis normalforbimto elimi-
natepbospbates inbis urine or contract bis pupils wben passing
quicklyfromtbedarkintotbeligbt.Adiseaseinastateofsuspen-
sionorremissionisnotanormalstateanalogoustotbeexercising
ofafunction,wboseblockagewouldbefatal. >imilarly,ifitisagood
ideatobearinmindtbeterrain as|asteurbimselfadvised,onesbould
perbaps still notgo totbelengtbofmakingamicrobe anepipbe-
nomenon.|ttakesonelastfragmentofcrystaltoobtaintbesolidi-
bcationofasupersaturedsolution.>trictlyspeaking,ittakesamicrobe
tomake an infection. Witboutdoubtitbas beenpossible to pro-
ducelesionsliketboseofpneumoniaortypboidbymeansofpbys-
icalorcbemicalirritationoftbesplancbnicnerve[80]. butinorder
tokeeptotbeclassicalexplanationofinfection, onecantry,once
infectionbasoccurred,toreestablisbacertaincontinuitybetween
beforeandafterbyusingetiological antecedents. |tseemsdifhcult
toasserttbattbeinfectiousstateproducesnorealdiscontinuityin
tbebistory of tbeliving being.
Nervousdiseasesconstituteanotberawkwardfactforbemard's
explanationbasedonbisprinciples.Tbesebavelongbeendescribed
intermsofexaggerationanddehciencyWbentbebigberfunctions
oflifeasitrelatestotbeextemalworldwereconsideredastbesums
of elementary redexes, and tbe brain centers as pigeonboles for
imagesorimpressions,aquantitativeexplanationofpatbologicalpbe-
nomenawasinevitable. buttbeconceptionsofUugblings ]ackson,
Ueadand>berrington,pavingtbewayformorerecenttbeoriessucb
as tbose of Coldstein,orientedresearcbindirectionswberefacts
tookonasyntbeticqualitativevalue,athrstignored.Wewillcome
backtotbislater.|twillbeenougbtosayberebrie|lytbataccord-
ingtoColdstein,normalbebaviorinrelationtolanguagedsturbances,
canbeexplainedinpatbological termsonlyontbe conditiontbat
tbenotionoftbemodihcationofpersonalitybydiseaseisintroduced.
|ngeneral, any oneactofanormalsubjectmust notbe related to
ananalogous actofa sickpersonwitboutunderstandingtbesense
andvalueof tbe patbological actfor tbepossibilities of existence
of tbe modihed organism.
Onemustrefrainfromtbinkingtbattbedifferentattitudespos-
sibleinasickpersonmerelyrepresentakindofresidueofnor-
malbebavior,wbatsurviveddestruction.Tbeattitudeswhcbbave
survivedintbe sickpersonneverturnupintbatforminanor-
malsubject,notevenintbeinferiorstagesofitsntogenesisor
pbylogenesis,asitisalltoofrequentlyadmitted. Liseasebasgiven
tbemparticularforms andtbeycannotbeunderstoodwellun-
less tbemorbidstate istakenintoaccount[45, 437].
|nsbort,tbecontinuityoftbenormalstateandtbepatbological
statedoesnotseemrealintbecaseofinfectiousdiseases,nomore
tban bomogeneity in tbe case of nervous diseases.
bywayofsummary, intbemedicaldomain,Claudebenard,witb
tbeautborityofeveryinnovatorwboprovesmovementbymarcb-
ing,formulatedtbeprofoundneedofanerawbicbbelievedintbe
omnipotenceofatecbnologyfoundedonscience,andwbicbfeltcom-
fortable in l in spite, or perbaps because of, romantic lamenta-
86
tions. An art of living as medicine is in tbefull sense of tbe
word impliesascienceoflife. Lfhcienttberapeuticsassumesex-
perimentalpatbology,wbicbintumcannotbeseparatednompbysi-
ology. '|bysiologyandpatbologyareintermingledandareoneand
tbesametbing. butmustitbededucedfromtbis,witbbrutalsim-
plicity,tbatlifeistbesameinbealtbanddisease,tbatitleamsnotb-
ingindiseaseandtbrougbit?Tbescienceofoppositesisone,said
Aristotle.Vustitbeconcludedfromtbistbatoppositesarenotop-
posites? Tbat tbe science of life sbould take so-callednormaland
so-calledpatbologicalpbenomenaas objects of tbe sametbeoret-
icalimportance,susceptibleofreciprocalclaribcationinordertomake
itselfhttomeettbe totalityof tbe vicissitudesoflifeinall its as-
pects,isurgentfarmoretbanitislegitimate.Tbisdoesnotmean
tbatpatbologyisnotbingotbertban pbysiology, andstilllesstbat
disease,asitrelatestotbenormalstate,representsonlyanincrease
ora reduction. |t isunderstood tbatmedicine needs anobjective
patbology, butresearcbwbicbcausesitsobjecttovanisbisnotob-
jective. Onecandenytbatdiseaseisa kindofviolationof tbeor-
ganismandconsideritasaneventwbicbtbeorganismcreatestbrougb
sometrickofitspermanentmnctions,witboutdenyingtbattbetrick
isnew. Anorganism's bebaviorcanbeincontinuitywithprevious
bebaviors and still beanotberbebavior. Tbeprogressivenessof an
adventdoesnotexcludetbeoriginalityofanevent.Tbefacttbata
patbologicalsymptom, consideredbyitself, expresses tbebyperac-
tivityofamnctionwboseproductisexactlyidenticalwitbtbeprod-
uctof tbe samefunctioninso-callednormalconditions, doesnot
mean tbat an organic disturbance, conceived asanotber aspect of
tbewboleoffunctionaltotalityandnotasasummapofsymptoms,
is not a new mode of be baviorfor tbe organism relative to its
environment.
|ntbehnalanalysis,woulditnotbeappropriatetosaytbattbe
patbologicalcanbedistinguisbedassucb,tbatis,asanalterationof
tbenonalstate,onlyattbeleveloforganictotality,andwbenit
concemsman,attbelevelofconsciousindividualtotality,wberedis-
easebecomesakindofevil?Tobesickmeanstbatamanreallylives
anotberlife,evenintbebiologicalsenseoftbeword.Toreturnonce
moretodiabetes, itisnotakidneydiseasebecauseofglycosuria,
norapancreaticdiseasebecauseofbypoinsulinemia,noradisease
oftbepituitary,itistbediseaseofanorganismallofwbosefunc-
tionsarecbanged,wbicbistbreatenedbytuberculosis,wbosesup-
peratedinfectionsareendless,wboselimbsarerendereduselessby
arteritisandgangrene,moreover,itcanstrikemanorwoman,tbreaten
tbemwitbcoma,oftenbittbemwitbimpotenceorsterility,forwbom
pregnancy,sboulditoccur,isacatastropbe,wbosetears 0 irony
ofsecretions' aresweet.' |tseemsveryartihcialtobreakupdis-
easeintosymptomsortoconsideritscomplicationsintbeabstract.
Wbatisasymptomwitboutcontextorbackground?Wbatisacom-
plicationseparatednomwbatitcomplicates?Wbenanisolatedsyp-
tomorafunctionalmecbanismistennedpatbological,oneforgets
tbatwbatmakestbemsoistbeirinnerrelationintbeindivisibleto-
tality ofindividualbebavior.Tbesituationissucbtbatiftbepbysi-
ologicalanalysisofseparatedfunctionsisknownintbepresenceof
patbologicalfacts,tbisisduetopreviousclinicalinfonation,for
clinicalpracticeputstbepbysicianincontactwitbcompleteandcon-
creteindividualsandnotwitborgansandtbeirfunctions.|atbol-
ogy,wbetberanatomicalorpbysiological,analyzesinordertoknow
more,butitcanbeknownaspatbology,tbatis,astbestudyoftbe
mecbanismsofdisease, onlyinsofarasitreceivesfromclinical
practicetbisnotionofdisease,wboseoriginmustbesougbtintbe
experiencemenbaveintbeirrelationswitb tbe wboleoftbeir
environment.
|ftbeabovepropositionsmakesomesense, bowcanwetben
explaintbattbemodernclinicianmorereadilyadoptstbepointof
viewoftbepbysiologisttbantbatoftbesickman?|tisundoubt-
88
edlybecauseoftbismassivefactofmedicalexperience,namelytbat
subjectivemorbidsymptomsandobjectivesymptomsrarelyover-
lap.|tissimplycapriciousforaurologisttosaytbatamanwbocom-
plainsof bis kidneysisa man wbo bas notbingwrong witb bis
kidneys. !ortbesickmantbekidneysareacutaneousmuscular
territoryintbelumbarregion,wbilefortbepbysiciantbeyarevital
organsconnectedtootbers.Tbewell-knownfactaboutreported
pains,wbosemultipleexplanationsbavebeenveryobscureuptonow,
preventsonefromtbinkingtbattbepainsexperiencedbytbesick
manasmajorsubjectivesymptomsbearaconstantrelationtotbe
underlyingorganstowbicbtbeyseemtocallattention.butmost
ofall,tbeoftenprolongedlatencyofcertaindegeneracies,tbein-
conspicuousnessofcertaininfestationsorinfectionsleadtbepbysi-
ciantoregardtbedirectpatbologicalexperienceoftbepatientas
negligible,eventoconsideritassystematicallyfalsifyingtbeobjec-
tive patbologicalfact. Lverypbysicianknows,bavinglearneditoc-
casionallytobisembarrassment,tbattbeimmediatesensibleawarenes
oforganiclifeinitselfconstitutesneitberascienceoftbesameor-
ganismnorinfallibleknowledgeoftbelocalizationordateoftbe
patbological lesions involving tbe buman body.
Uereis perbapswbyuntilnowpatbologybasretainedso little
oftbatcbaracterwbicbdiseasebasfortbesickman ofbeing
reallyanother way _|;.Certainlypatbologyiscorrectinsuspect-
ingandrectifyingtbeopinionoftbesickmanwbo,becausebefeels
different,tbinksbealsoknowsinwbatandbowbeisdilIerent.| t
doesnotfollowtbatbecausetbesickmani sclearlymistakenontbis
secondpoint,beisalsomistakenontbehrst.|erbapsbisfeelingis
tbeforesbadowingofwbatcontemporarypatbologyisj ustbegin-
ningtosee,namelytbattbepatbologicalstateisnotasimple,quan-
titativelyvariedextensionoftbepbysiologicalstate,butsometbing
else entirely.' "
CHAPTER | \
The Conce
p
tions of Rene Leriche
Tbe invalidityof tbe sickman'sj udgmentconcerningtbe reality
ofbisownillnessisanimportanttbemeinarecenttbeoryofdis-
ease. TbisisLericbe's tbeory, wbicb, tbougbattimesratberwa-
vering,isnuanced, concreteandprofound. |tseemsnecessaryto
presentandexamine itafter tbe precedingtbeory, wbicb itex-
tendsinonedirectionandfromwbicbitclearlydeviatesinotb-
ers.'Uealtb,saysLericbe,'islifelivedin tbesilenceoftbeorgans
[73, 6. 16-7]. Conversely, 'diseaseiswbatirritatesmenintbenor-
malcourseoftbeirlivesandwork,andaboveall,wbatmakestbem
suffer[73, 6. 22-3]. Tbe state of bealtbisa state of unaware-
nesswberetbesubjectandbisbodyareone.Conversely,tbeaware-
nessof tbe bodyconsistsin afeelingoflimits,tbreats,obstacles
to bealtb.Takingtbeseformulaeintbeirfullsense,tbeymeantbat
tbeactual notionoftbenormaldependsontbepossibilityofvi-
olatingtbenorm. Uereatlastaredebnitionswbicbarenotempty
words, wbere tbe relativity of tbe contrasting terms is correct.
!oralltbattbeprimitivetermisnotpositive,foralltbat tbeneg-
ativetermdoesnotrepresentnotbingness. Uealtbispositive,but
notprimitive, diseaseisnegative,butintbeform of opposition
(irritation), not deprivation.
Nevertbeless, if neitber reservation norcorrectionissubse-
quentlybrougbttobearontbedehnitionofbealtb,tbedeb nition
ofdiseaseisimmediatelystraigbtenedout. !ortbisdehnitionof
diseaseistbatoftbesickman,nottbatoftbe doctor, and valu-
able tbougb it isfrom tbe point of viewof awareness, it is not
tbepointofviewofscience. Lericbesbows, ineffect,tbattbesi-
lenceoftbeorgansdoesnotnecessarilyequaltbeabsenceofdis-
ease,tbattberearefunctionallesionsorperturbationswbicblong
remainimperceptibletotbosewboselivestbeyendanger.|tiswitb
tbefrequentdelayinfeelingourinternalirregularitiestbatwepay
fortbeprodigalitywitbwbicbourorganismbasbeenconstructed,
foritbas too many of every tissue. morelungs tbanare strictly
requiredfor breatbing,more kidneys tbanare neededto secrete
urinetotbeedgeof intoxication.Tbeconclusionistbat'if one
wants to dehne disease, it must be debumanized 71, 6 223],
andmorebrutally,'indisease,wbenallissaidanddone,tbeleast
importanttbingisman71, 6 224]. Uenceitisnolongerpain
orfunctionalincapacityandsocialinhrmitywbicbmakesdisease,
butratberanatomicalalterationorpbysiologicaldisturbance.Lis-
easeplaysitstricksattbetissuelevel,andintbissense,tberecan
besicknesswitboutasickperson.Take,for example,amanwbo
basnevercomplainedofpatbologicaloccurrencesandwboselife
iscutsbortbymurderoracarcrasb.AccordingtoLericbe'stbe-
ory, ifanautopsyofmedicallegalintentweretorevealacancer
oftbekidneyunknowntoitslateowner,onesbouldconcludein
favorof a disease,altbougbtberewouldbenoone towbom to
attribute it neitber to tbe cadaver wbicb is no longer compe-
tent,norretroactivelytotbeformerlylivemanwbobadnoidea
ofit,bavingbadbislifecometoanendbeforetbecancer'sstage
ofdevelopmentatwbicb,inallclinicalprobability,painwouldbave
bnallyannouncedtbe illness. Tbe diseasewbicbneverexistedin
tbeman'sconsciousnessbeginstoexistintbepbysician'sscience.
We tbink that there is nothins in science that has not frst appeared
THE CONCEPTIONS OF RENE LERICHE
in the consciousness, and tbat intbe case nowbefore us, itispar-
ticularly tbe sickman's pointof view wbicbforms tbe basis of
trutb.Andbereiswby. Loctors andsurgeonsbaveclinicalinfor-
mationandsometimesuselaboratorytecbniqueswbicballowtbem
tosee 'patientsinpeoplewbodonotfeeltbatway.Tbis isafact.
butafacttobeinterpreted. |tisonlybecausetoday'spractition-
ersaretbebeirstoamedicalculturetransmittedtotbembyyes-
terday'spractitionerstbat, intermsofclinicalperspicacity, tbey
overtakeandoutstriptbeirregularoroccasionalclients.Tberebas
alwaysbeen a moment wben, all tbings considered, tbe practi-
tioner'sattentionbasbeendrawntocertainsymptoms,evensolely
obj ective ones , bymen wbo were complaini ng of not being
normal tbat is, of notbeingtbesameas tbeybadbeenin tbe
past orofsuffering.|f,today,tbepbysiciansknowledgeofdis-
easecananticipatetbe sickman'sexperienceof it, itisbecause
atonetimetbisexperiencegaveriseto,summonedup,tbatknowl-
edge.Uencemedicinealwaysexistsde
j
ure, ifnotde facto, because
tberearemenwbofeelsick,notbecausetberearedoctorstotell
menoftbeirillnesses.Tbebistoricalevolutionoftberelationsbe-
tween tbe pbysi cian andtbe sick manin clinical consultation
cbangesnotbingintbenormal,permanentrelationsbipoftbesick
mananddisease.
Tbiscritique can be all tbemoreboldlypropounded intbat
Lericbe,retractingwbatwas too trencbant in bis hrst formula-
tion,partiallyconhrmsit.Carefullydistinguisbingtbestaticfrom
tbedynamicpointofviewinpatbology, Lericbeclaimscomplete
primacyfor tbe latter.Totbosewbowouldidentify disease and
lesion, Lericbe objected tbattbe anatomical factmustinreality
beconsidered'secondandsecondary. second, becauseitispro-
ducedbya primitivelyfunctionaldeviationintbelife oftbetis-
sues, secondary,becauseitisonlyoneelementintbediseaseand
nottbedominantone[73, 6. 76-6]. Consequently, itistbesick
93
man`sdiseasewbicbveryunexpectedlybecomesagaintbeadequate
conceptof disease,moreadequate inany case tbantbeconcept
of tbeanatomicalpatbologist.
Tbeideamustbeacceptedtbattbediseaseoftbesickmanis
nottbeanatomicaldiseaseoftbedoctor.Astoneinanatropbic
gallbladdercanfailtogivesymptomsforyearsandconsequently
create no disease, altbougb tbere is a state of patbological
anatomy. .. . Undertbesameanatomicalappearancesoneissick
andoneisn't.. . . Tbedifhcultymustnolongerbeconj uredaway
bysimplysayingtbattbereare silentandmaskedformsof dis-
ease.tbesearenotbingbutmerewords.Tbelesionisnotenougb
perbapstomaketbeclinicaldiseasetbediseaseoftbesickman,
for tbisdiseaseissometbingotbertbantbediseaseoftbean-
atomicalpatbologist [ibid. ].
buti ti snotagoodideatocreditLericbewitbmoretbanbebas
decidedto accept. Wbat be infactmeans bytbe sick person is
mucbmore tbe organism inaction, infunctions, tban tbe indi-
vidualaware of bis organicfunctions. Tbe sickmanin tbisnew
dehnitionisnotwbollytbesickmanoftbeb rst,tbeactualman
awareofbisfavoredordisfavoredsituationi nlife.Tbesickman
basceasedtobeanentityfortbeanatomistbutberemainsanen-
tity for tbe pbysiologist, for Lericbe states precisely. 'Tbis new
representationofdiseaseleadsmedicineintoclosercontactwitb
pbysiology, tbat is, witbtbe science of functions, andleadsitto
concemitselfatleastasmucbwitbpatbologicalpbysiologyaswitb
patbologicalanatomy[ibid. ]. Tbus,tbecoincidenceofdiseaseand
tbesickmantakesplaceintbepbysiologist'sscience,butnotyet
intberealman'sconsciousness. Andyettbis hrst coincidence is
enougb,forLericbebimselfprovidesuswitbtbemeanstoobtain
from tbis tbe second.
94
TakingupClaudebernard'sideas certainlyinfullawareness
Lericbealsoassertstbecontinuityandindiscernabilityof tbe
pbysiologicalstateandtbepatbologicalstate. !orexample,inform-
ingtbetbeoryofvasoconstrictivepbenomena(wboselongunrec-
ognizedcomplexitybedemonstrated)andtbeirtransformationinto
spasm pbenomena, Lericbe writes.
From tonus to vaso-constriction, that is, to physiological hyperto
nia, fom vaso-constriction to spasm, . there is no borderline. Onepasses
from one state to tbe otber witbout transition, and itis tbe
effectsratbertbantbetbingitselfwbicbmakesfordifferenti-
ations. betweenpbysiologyandpatbologytbereisnotbresb-
old[74, 234].
Letusunderstandtbislastformulationclearly.Tbereisnoquan-
titativetbresboldwbicbcanbedetectedbyobjectivemetbodsof
measurement.buttbereisnonetbelessqualitativedistinctionand
oppositionintermsoftbedilIerenteffectsoftbesamequantita-
tivelyvariable cause.
Lvenwitbperfectconservation of tbearterial structure, tbe
spasm, ata distance, basgravepatbological effects. itcauses
pain,producesfragmentedordiffusenecroses,lastandnotleast
itgivesrisetocapillaryandarterialobliterationattbeperipb-
eryof tbe system[74, 234].
Obliteration,necrosis,pain tbesearepatbologicalfactsforwbicb
pbysiological equivalents are sougbt in vain. a blocked arteryis,
pbysiologicallyspeaking,nolongeranartery, sinceitisanobsta-
cle,andnolongerapatbforcirculation,pbysiologically,anecrotic
cell is no longer a cell, since, if tbere is an anatomy of tbe ca-
daver,intermsofanetymologicaldeb nition,tberecouldnotexist
95
apbysiologyoftbecadaver,hnally, painisnotapbysiologicalsen-
sationbecause,accordingtoLericbe,'painisnotinnature'splan.
Asfarastbeproblemofpainisconcerned,Lericbe'soriginal
andprofoundtbesisisknown. |tisimpossibletoconsiderpainas
tbeexpressionofanormalactivity, ofasensesusceptibleofper-
manentexercise,asensewbicbwouldexertitselftbrougbtbeorgan
ofspecialized,peripberalreceptors,ofsuitablepatbsofnervous
conductionanddelimitedcentralanalyzers,equallyimpossibleto
considerpain eitber as adetectorof and diligent warning signal
forevents menacing organic integrity from witbin and witbout,
orasareactionofsalutarydefensewbicbtbedoctorsbouldre-
spectandevenreinforce.|ainis'amonstrousindividualpbenome-
non and not a law of tbe species. A fact of disease[74, 490].
Wemustunderstandtbefullimportanceoftbeselastwords.Lis-
easeisnolongerdebnedintermsofpain.ratber,painispresented
as disease. Andwbat Lericbe understands tbis time as disease is
nottbequantitativemodibcationofapbysiologicalornormalpbe-
nomenon butratberan autbenticallyabnormal state. '|ain-disease
inusislikeanaccidentwbicbrunscountertotbelawsofnormal
sensation. . . . Lverytbingaboutitisabnormal, rebelsagainsttbe
law[ibid. ]. At tbis point Lericbe issosensibleof bisdeparture
fromaclassicaldogmatbatbefeelstbeveryfamiliarneedtocall
uponitsmajestyattbeverymomenttbatbeisforcedtounder-
mineitsfoundations. 'Yes,ofcourse,patbologyisneveranytbing
buta pbysiologygonewrong. |twasattbeCollgede!rance,in
tbiscbairtbattbisideawasbomandevepdayitstrikesusasbeing
increasinglytrue[74, 482]. Tbepbenomenonofpaintbusverihes
electivelyLericbe'sever-presenttbeoryoftbestate ofdiseaseas
a'pbysiologicalnovelty. Tbisconceptioncomestoligbtinatimid
wayintbelastpagesof\ol. \|oftbeEnccopedie janraise (1 936):
Liseaseno longerappears tousas aparasitelivinginandoff
oftbe man itconsumes. We see bere tbe consequence of a
deviation smallatbrst oftbepbysiologicalorder. |nsbort,
itisanewpbysiologicalordertowbicbtberapeuticsmustaim
to adapt tbe sickman 71, 6 /66].
buttbisconception is plainlyassertedby tbefollowing.
Tbeproductionofasymptom,evenamajorone,inadog,does
not mean tbat we bave brougbt about a buman disease. Tbe
latter isalways anaggregate. Tbat wbicb producesdiseasein
us toucbes life's ordinary resiliences so subtly tbattbeirre-
sponsesarelesstbatof apbysiologygonewrongtbantbatof
anewpbysiologywberemanytbings,tunedinanewkey, bave
unusual resonance76, / l ].
|tisnotpossibleforustoexaminetbistbeoryofpainforitsown
sakewitballtbeattentionitdeserves, but we must still indicate
itsinterestfortbeproblemconcerningusbere.|tseemsquiteim-
portant to us tbat a doctor recognize in paina pbenomenon of
totalreactionwbicbmakessense,wbicbisasensationonlyattbe
levelofconcretebumanindividuality '|bysicalpainisnotasim-
ple question of nerve impulsesmoving at a bxed speed along a
nerve. It is the result of the confict between a stimulant and the indi
vidual as a whole " 7+, 4]. |tseemstousquiteimportanttbata
doctor state tbat man makes bis pain asbe makes a disease or
asbemakesbismouming ratbertbantbatbereceivesitorsub-
mitstoit. Conversely, toconsiderpainasanimpressionreceived
atapointoftbebodyandtransmittedtotbebrainistoassume
tbatitiscompleteinandofitself,witboutanyrelationtotbeac-
tivityoftbesubjectwboexperiencesit.|tispossibletbattbein-
adequacyofanatomicalandpbysiologicaldataintbisproblemgives
Lericbecompletefreedom,startingfromotberpositivearguments,
97
todenytbespecihcityofpain.buttodenytbeanatomicandpbys-
iological specihcityof a nerve apparatus peculiar topainis not,
inouropinion,necessarilytodenytbefunctionalcbaracterofpain.
Certainly, itistoo obvious tbatpainisnotalways a faitbful and
infalliblewarningsignal, tbattbehnalistsarekiddingtbemselves
by assigningitpremonitory capacities andresponsibilitieswbicb
no science of tbe buman body would want to assume. but it is
equallyobvioustbatindifferenceontbepartof alivingbeingto
bisconditionsoflife,totbequalityofbisexcbangeswitbbisen-
vironment, isprofoundlyabnormal. |tcanbeadmittedtbatpain
isavitalsensationwitboutadmittingtbatitbasaparticularorgan
ortbat it bas encyclopedic value as a mine of information witb
regardtotbetopograpbicalorfunctionalorder.Tbepbysiologist
canindeeddenouncetbeillusionsofpainastbepbysicistdoestbose
of sigbt, tbis means tbatsensationisnotknowledgeandtbatits
normalvalueisnotatbeoreticalvalue,buttbisdoesnotmeantbat
itisnormallywitboutvalue. |tseemstbatonemustaboveallcare-
fullydistinguisbpainofintegumentarysurface]originfrompain
ofvisceralorigin. |ftbelatterispresentedasabnormal,itseems
difhcultto dispute tbenormal cbaracterof pain wbicbarises at
tbesurfaceoftbeorganism's separationfromaswellas encoun-
terwitbtbeenvironment.Tbesuppressionofintegumentarypain
insclerodermaorsyringomyeliacanleadtotbeorganism'sindif-
ference to attacks on its integrity.
butwbatwemustbearinmindis tbatLericbe,indehningdis-
ease, seesnootberwaytodehneitexceptintermsofitseffects.
Nowwtbatleastoneoftbeseeffects,pain,weunequivocallyleave
tbe plane of abstract sciencefortbe spbere of concrete aware-
ness. Tbistimeweobtaintbetotal coincidenceof diseaseandtbe
diseased person,forpain-disease, to speak as Lericbe does, is a
factattbeleveloftbeentireconsciousindividual,itisafactwbicb
Lericbe'sbneanalyses,relatingtbeparticipationandcollaboration
of tbe wbole individual to bis pain, allow usto call 'bebavior.
!rom bereon inwe can see clearlyinwbatways Lericbe'sideas
extendtboseofComteandbernardand,beingsubtlerandricber
inautbenticmedical experience, inwbatwaystbeydeviatefrom
tbem,forwitbregardtotberelationsbetweenpbysiologyandpa-
tbologyLericbebringstobeartbejudgmentoftbetecbnician,not
tbatof tbepbilosopberlike Comte ortbescientistlikebernard.
TbeideawbicbComteandbernardbaveincommon despitetbe
differenceinintentionsmentionedabove istbatnormallyatecb-
nologymustbetbeapplicationofascience.Tbisistbefundamen-
talpositivist idea. toknowinordertoact.|bysiologymusttbrow
ligbtonpatbologyinordertoestablisbtberapeutics.Comtetbougbt
tbatdiseaseservedasasubstituteforexperiments,andClaudeber-
nard, tbatexperiments,even tbose performedonanimals,led us
totbediseasesofman. but,intbebnalanalysis,forbotbmenwe
canprogresslogicallyonlyfromexperimentalpbysiologicalknowl-
edgetomedicaltecbnology. Lericbebimselftbinks tbatweprog-
ress more often in fact and sbould always in tbeory from
medicalandsurgicaltecbnologypromptedbytbepatbologicalstate
topbysiologicalknowledge. knowledgeoftbepbysiologicalstate
isobtainedbyretrospectiveabstractionfromtbeclinicalandtber-
apeutic experience.
We canaskourselveswbetbertbestudyofnormalman,even
wbenitisbasedontbatofanimals,willeverbeenougbtoin-
formusfullyabouttbenormallifeofman.Tbegenerosityof
tbe plan onwbicbwe are builtmakes analysisverydifhcult.
Aboveall,tbisanalysisiscarriedoutbystudyingtbedebciencies
produced by tbe suppressionof organs, tbat is, byintroduc-
ing variables intbe orderof life and lookingfor tbe conse-
99
quences. Unfortunately, witbabealtbypersonexperimentation
is always a bit brutal in its determinismandtbe bealtby man
quicklycorrectstbesligbtestspontaneousinsufbcienc
|tisper-
baps easierwben variablesareintroducedinto manimpercep-
tiblybymeansofdisease,ortberapeutically, once disease bas
struck. Tbe sick man cantbus advance knowledge abouttbe
normal man. bystudyingbim, deb ciencies are discovered in
bimtbattbemostsubtleexperimentwouldfailtoproducein
animals,andtbankstowbicbnormal life can beregained. |n
tbiswaytbecompletestudyofdiseasetendstobecomeanin-
creasinglyessentialelementofnormal pbysiology71, 6./66].
Obviously,tbeseideasareclosertotboseofComtetbantotbose
ofClaude bernard butwitb abigdifference. Aswe baveseen,
Comtetbinkstbatknowledgeoftbenormalstatemustnormally
precede an evaluation of tbepatbological state andtbat,strictly
speaking, itcouldbeformed tbougbwitbouttbeabilitytoex-
tendveryfar witbouttbesligbtestreferencetopatbology,simi-
larly, Comte defends tbeindependenceof tbeoreticalbiologyin
relationtomedicineandtbrapeuticsz7,24/]. bycontrast,Lericbe
tbinks tbat pbysiologyistbecollectionof solutionstoproblems
posedbysickmentbrougbtbeirillnesses. Tbis isindeedoneof
tbe most profound insigbts ontbe problem of tbe patbological.
'Ateverymomenttbereliewitbinusmanymorepbysiologicalpos-
sibilities tbanpbysiologywouldtellusabout.butittakesdisease
torevealtbemtous76,i i ]. |bysiologyistbescienceoftbefunc-
tionsandwaysoflife,butitislifewbicbsuggeststotbepbysiol-
ogisttbewaystoexplore,forwbicbbecodibestbelaws.|bysiology
cannotimposeonlifej usttbosewayswbosemecbanismisintel-
ligible toit. Liseasesarenewwaysoflife.Witbouttbe diseases
wbicbincessantlyrenewtbeareatobeexplored,pbysiologywould
marktime on well-trodground. but tbeforegoing idea can also
1 00
beunderstoodinanotber,sligbtlydilIerentsense.Liseasereveals
normal functions to usat tbe precise moment wben it deprives
us of tbeirexercise. Liseaseistbe sourceof tbespeculativeat-
tention wbicblife attacbes to life bymeansofman. |f bealtb is
life intbe silenceof tbeorgans,tben, strictlyspeaking, tbereis
noscienceofbealtb.Uealtbisorganicinnocence.|tmustbelost,
likeallinnocence,sotbatknowledgemaybepossible. |bysiology
is like all science, wbicb, as Aristotle says, proceeds from won-
der. buttbetrulyvitalwonderistbeanguisb caused bydisease.
|twasnoexaggerationtoannounceintbeintroductiontotbis
cbaptertbatLericbe'sconceptions,placedonceagaininbistori-
calperspective,wouldbeabletotakeonunexpectedempbasis. |t
does notseem possible tbat anypbilosopbicalormedical explo-
rationoftbetbeoreticalproblemsposedbydiseasecanignoretbem
in tbe future. At tbe risk of offending certain minds for wbom
tbeintellectis realizedonlyinintellectualism,letmerepeatonce
moretbattbeintrinsicvalueofLericbe'stbeory independentof
anycriticismapplicabletosomedetailsofcontent liesintbefact
tbatitistbetbeoryofatecbnology, atbeoryforwbicbtecbnol-
ogyexists, notasadocileservantcarryingoutintangibleorders,
butasadvisorandanimator,directingattentiontoconcreteprob-
lemsandorientingresearcbintbedirectionofobstacleswitbout
presuminganytbinginadvanceoftbetbeoreticalsolutionswbicb
will arise.
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CHAPTER \
Im
p
licat ion s of a Theor
y
'Vedicine,says>igerist, 'is tbemostcloselylinkedtotbewbole
ofculture,everytransformationinmedicalconceptionsbeingcon-
ditionedbytransformationsintbeideas oftbeepocbl07,42].
Tbetbeorywejustexpounded,atoncemedical,scientihcandpbil-
osopbical, perfectlyverihestbisproposition. |tseemstoustosat-
isfysimultaneouslyseveraldemandsand intellectual postulates of
tbebistoricalmomentoftbecultureinwbicbitwasformulated.
!irstof alltbere emerges fromtbistbeorytbeconvictionof
rationalistoptimismtbatevilbasnorealityWbatdistinguisbesnine-
teentb-centurymedicine(particularlybeforetbeeraof |asteur)
inrelationtotbemedicineofearliercenturiesisitsresolutelymo-
nistcbaracter.Ligbteentb-centurymedicine,despitetbeeffortsof
tbeiatromecbanistsandiatrocbemists,andundertbein|luenceof
tbeanimistsandvitalists,remaineda dualistmedicine,amedical
Vanicbaeanism.UealtbandLiseasefougbtovermantbewayCood
andLvilfougbtovertbeWorld. |tiswitbagreatdealofintellec-
tual satisfaction tbat we take up tbe following passage in a bis-
toryofmedicine.
|aracelsuswasavisionary, \anUelmont,amystic,>tabl,api-
etist. Alltbreewereinnovativegeniusesbutwerein|luenced
1 03
bytbeirenvironmentandbyinberitedtraditions.Wbatmakes
appreciationoftbereformdoctrinesoftbesetbreegreatmen
very bard istbe extreme difhculty one experiences in trying
toseparate tbeir scientihcfromtbeir religiousbeliefs. . . . |t is
notat all certain tbat |aracelsus did not believe tbat be bad
foundtbeelixiroflife,itiscertaintbat\anUelmontidentihed
bealtbwitbsalvationandsicknesswitbsin,andinbisaccount
ofTheoria medica vera >tablbimself,despitebisintellectualvigor,
availedbimselfmore tban beneededtoof tbe beliefinorigi-
nal sin and tbefall of man[48, 31 1].
Voretbanbeneededto'saystbeautbor,quitetbegreatadmirer
ofbroussais,swornenemyattbedawnoftbenineteentbcentury
of all medical ontology. Tbedenialofanontological conception
ofdisease,anegativecorollaryof tbeassertionofaquantitative
identitybetweentbenormalandtbepatbological,ishrst,perbaps,
tbe deeperrefusal to conhrm evil. |tcertainlycannotbe denied
tbata scientihc tberapeuticsissuperiortoamagical ormystical
one. |t is certain tbatknowledgeisbettertban ignorance wben
actionisrequired,andintbis sense tbe valueoftbepbilosopby
oftbeLnligbtenmentandofpositivism,evenscientistic,isindis-
putable. |twouldnotbea question of exempting doctors from
tbestudyofpbysiologyandpbarmacology |tisveryimportantnot
toidentifydiseasewitbeitbersinortbedevil.butitdoes notfol-
lowfromtbefacttbatevilisnotabeing,tbatitisaconceptde-
voidofmeaning,itdoesnotfollowtbattberearenonegativevalues,
evenamong vital values,itdoes notfollowtbat tbepatbological
stateis essentially notbing otber tban tbe normal state.
Conversely, tbetbeoryinquestionconveystbebumanistcon-
victiontbatman'sactiononbisenvironmentandonbimselfcan
andmustbecomecompletelyonewitbbisknowledgeof tbeen-
vironmentandman, itmustbenormallyonlytbeapplicationof
1 0
4
IMPLICATI ONS OF A THEORY
apreviouslyinstitutedscience. LookingattbeLecons sur le diabhe
LecturesonLiabetes]itisobvioustbatifoneassertstberealbo-
mogeneityandcontinuityoftbenormalandtbepatbologicalitis
inordertoestablisbapbysiologicalsciencetbatwouldgovemtber-
apeuticactivitybymeansoftbeintermediaryofpatbology. Uere
tbefacttbatbumanconsciousnessexperiencesoccasionsofnew
growtbandtbeoreticalprogressinitsdomainofnontbeoretical,
pragmaticandtecbnicalactivityisnotappreciated.Todenytecb-
nologyavalueallitsownoutsideoftbeknowledgeitsucceedsin
incorporating,istorenderunintelligibletbeirregularwayoftbe
progressofknowledgeandtomisstbatovertakingofscienceby
tbepowerwbicbtbepositivistsbavesooftenstatedwbiletbeyde-
ploredit. |ftecbnology'srasbness,unmindfuloftbeobstaclesto
be encountered, did not constantlyanticipate tbe prudence of
codihedknowledge,tbenumberofscientihcproblemstoresolve,
wbicbaresurprisesafterbavingbeensetbacks,wouldbefarfewer.
Uere is tbe trutb tbat remains in empiricism, tbe pbilosopby of
intellectualadventure,wbicbanexperimentalmetbod,ratbertoo
tempted, by reaction, torationalize itself, failed to recognize.
Nevertbeless,Claudebernardcannotbereproacbed witbout
ourbeinginaccurate forbavingignoredtbe intellectual stimu-
lusfoundbypbysiologyinclinicalpractice.Uebimselfacknowl-
edged tbe fact tbat bi s experiments onglycemia and glucose
productionintbeanimalorganismbaveastbeirpointofdepar-
tureobservationsrelatedtodiabetesandtbedisproportionsome-
times noticeable between tbe amount ofcarbobydrates ingested
andtbe amount ofglucose eliminated bytbe urine. Ue bimself
formulated tbefollowinggeneral principal. Tbe medical prob-
lemmusthrstbeposedsotbatitisgivenbyobservationof tbe
disease, andtbentbepatbological pbenomena mustbeanalyzed
experimentallyasonetriestoprovideapbysiologicalexplanation
fortbem6,34-]. Lespiteeverytbing,itisstilltruetbatforber-
nardtbepatbologicalfactanditspbysiologicalexplanationdonot
bave tbe same tbeoretical importance. Tbe patbological factac-
ceptsexplanationmoretbanitstimulatesit.Tbisisevenmoreob-
viousintbefollowingtext. 'Liseasesareessentiallynotbingbut
pbysiologicalpbenomenainnewconditionswbicbbavetobedeter-
mined6,346].!orwboeverknowspbysiology,diseasesveri[tbe
pbysiologybeknows, butessentiallytbeyteacbbimnotbing,pbe-
nomenaaretbesameintbepatbologicalstate,saveforconditions.
Asifonecoulddetermineapbenomenon'sessenceapartfromits
conditions'Asifconditionswereamaskorframewbicbcbanged
neitbertbefacenortbepicture'Onesbould comparetbispropo-
sitionwitbtbatofLericbecitedaboveinordertofeelalltbeex-
pressiveimportanceofaverbalnuance.'Ateverymomenttbere
liewitbin usmanymorepbysiological possibilities tban pbysiol-
ogy tells us about. butittakes disease to reveal tbem to us.
Uereagainweowetotbecbanceofbibliograpbicalresearcbtbe
intellectualpleasureof statingoncemoretbattbemostapparently
paradoxicaltbesesalsobavetbeirtraditionwbicbundoubtedlyex-
pressestbeirpermanentlogicalnecessity. ]ustwbenbroussaiswas
lending bis autboritytotbetbeorywbicbestablisbedpbysiologi-
calmedicine,tbissametbeorywasprovokingtbeobjectionsofan
obscurepbysician,oneLr. \ictor |rus,wbowasrewardedbytbe
>ocitdeVdecineduCardinl zl forareportenteredinacom-
petition wbose obj ect was tbe precise dehnition of tbe terms
pblegmasiaandirritationandtbeirimportanceforpracticalmedi-
cine. Afterbaving cballenged tbe idea tbatpbysiology by itself
forms tbenaturalfoundationofmedicine,tbatitalonecanever
establisb tbe knowledge of symptoms, tbeir relationsbips and
tbeirvalue,tbatpatbologicalanatomycaneverbededucedfrom
tbe knowledge of normal pbenomena, tbat tbe prognosis of di-
seases derives from tbe knowledge of pbysiological laws, tbe
autboradds.
1 06
IMPLICATIONS OF A THEORY
|f we want toexbaust tbe questiondealtwitbin tbis arti-
clewewould bave tosbowtbatphysiology far from being the
foundation of pathology, could onl arise in opposition to it. |t
istbrougbtbe cbanges wbicb tbe disease of anorganand
sometimestbecompletesuspensionofitsactivitytransmitto
itsfunctionstbatwe learntbeorgan's use andimportance. . . .
Uencean exostosis, by compressing andparalyzing tbe optic
nerve,tbebracbialnerves,andtbespinalcord,sbowsustbeir
usual destination. broussonnet lost bis memory of substan-
tivewords, atbisdeatban abscesswasfoundintbe anterior
partof bis brain andone was ledto believe tbattbat istbe
centerfor tbe memory of names. . . . Tbus patbology, aided
bypatbological anatomy, bas created pbysiology. everyday
patbology clears up pbysiology's former errors and aids its
progress 9, I].
|nwritingtbeIntroduction c i'itude de la medecine expeimentale,
Claudebernardsetouttoassertnotonlytbatefhcaciousaction
is tbe same as science, but also, and analogously, tbat science
is identical witbtbe discoveryof tbe laws of pbenomena. On
tbis pointbisagreementwitb Comte is total. Wbat Comte in
bis pbilosopbical biology calls tbedoctrineof tbe conditions
ofexistence,bernardcallsdeterminism.Ue|lattersbimselfwitb
bavingbeentbebrsttointroducetbattermintoscientibc!rencb.
|believe|amtbebrsttobaveintroducedtbiswordtoscience,
butitbasbeenusedbypbilosopbersinanotbersense. |twill
beuseful to determine tbemeaningof tbis word in a book
wbicb|plantowrite.Du diterminisme dans les sciences OnLe-
terminismintbe>ciences]. Tbiswillamounttoasecondedi-
tion of my Introduction c la medecine experimentale l01, -6].
1 07
|tisfaitbintbeuniversalvalidityoftbedeterministpostulatewbicb
isassertedbytbeprincipal
pbysiologyandpatbologyareoneand
tbesametbing. Attbeverytimetbatpatbologywassaddledwitb
prescientihcconcepts,apbysicocbemicalpbysiologyexisted wbicb
mettbedemandsofscientihcknowledge,tbatis,apbysiologyof
quantitativelawsverihedbyexperimentation. Understandablyearly
nineteentb-century pbysicians, justihably eager for an effective,
rationalpatbology, sawinpbysiologytbeprospectivemodelwbicb
came closest to tbeirideal.
>ciencerejectstbeindeterminate , andinmedicine,wbenopin-
ionsarebasedonmedicalpalpation,inspiration,oramoreor
lessvagueintuitionabouttbings,weareoutsideofscienceand
aregiventbeexampleof tbis medicine offantasy, capableof
presentingtbegravestperils asitdelivers tbebealtbandlives
of sickmen to tbe wbims of an inspiredignoramus 6, -6].
butjustbecause,oftbetwo pbysiologyandpatbology onlytbe
hrst involvedlaws andpostulatedtbedeterminismof its object,
itwasnotnecessarytoconcludetbat,giventbelegitimatedesire
for arationalpatbology, tbelawsanddeterminismofpatbologi-
calfactsaretbesamelawsanddeterminismofpbysiologicalfacts.
We knowtbeantecedentsoftbispointofdoctrinefrombernard
bimsell. |ntbelecturedevotedtotbelifeandworksofVagendie
attbebeginningoftbeLefons sur les substances tOxiques et medicament
euses Lectures onToxicandVedicinal >ubstances]( l 7),ber-
nardtellsus tbattbe teacberwbosecbairbeoccupiesandwbose
teacbingbecontinuesdrewtbefeelingofrealsciencefromtbe
illustriousLaplace.WeknowtbatLaplacebadbeenLavoisier'scol-
laboratorintbe researcb onanimal respirationandanimalbeat,
tbehrstbrilliantsuccessinresearcbontbelawsofbiologicalpbe-
nomenafollowingtbeexperimental andmeasuringmetbodsen-
1 08
IMPLICATIONS OF A THEORY
dorsedbypbysicsandcbemistry.As aresultoftbisworkLaplace
bad retained a distinct taste forpbysiology andbe supported
Vagendie. |f Laplace neverusedtbe term 'determinism, be is
oneofitsspiritualfatbersand,atleastin!rance,anautboritative
andautborizedfatberoftbedoctrinedesignatedbytbeterm.!or
Laplacedeterminismisnotametbodologicalrequirement,anor-
mative researcbpostulatesufb ciently |lexible toprejudiceinany
way tbe form of tbe results to wbicbitleads. itisrealityitself,
complete, cast ne varietur in tbe framework of Newtonian and
Laplacianmecbanics. Leterminismcanbeconceivedasbeingopen
toincessantcorrectionsof tbeformulaeoflawsandtbeconcepts
tbeylinktogetber,orasbeingcosed onitsownassumeddehnitive
content. Laplace constructed tbe tbeoryof closed determinism.
Claudebernarddidnotconceiveof itinanyotberwayandtbis
isundoubtedlywbybe didnot believetbat tbecollaborationof
patbologyandpbysiologyco
ldleadtoaprogressiverectibcation
ofpbysiological concepts. |tisappropriateberetorecall Wbite-
bead's dictum.
Lveryspecialsciencebastoassumeresultsfromotbersciences.
!orexample,biologypresupposespbysics.|twillusuallybetbe
casetbattbeseloansreallybelongtotbestateofsciencetbirty
orfortyyearsearlier.Tbepresuppositionsoftbepbysicsofmy
boybood are today powerful in|luencs in tbe mentalityof
pbysiologists.
20
!inally,asaresultoftbedeterministpostulate,itistbereduction
of qualityto quantitywbicb is impliedby tbe essential identity
ofpbysiologyandpatbology. Toreducetbedifferencebetweena
bealtby man and a diabetic to a quantitative dif|erence of tbe
amountof glucosewitbin tbe body, todelegatetbe taskof dis-
tinguisbing one wbo is diabetic from one wbo is not to a renal
tbresboldconceivedsimplyas a quantitative difference of level,
meansobeyingtbe spiritof tbe pbysical scienceswbicb,inbut-
tressingpbenomenawitblaws,canexplaintbemonlyintermsof
tbeirreductiontoacommonmeasure.|nordertointroduceterms
intotberelationsbipsofcompositionanddependence,tbebomo-
geneityoftbesetermssbouldbeobtainedhrst.AsLmileVeyerson
bassbown,tbebumanspiritattainedknowledgebyidentifyingre-
ality and quantity. butit sbould be rememberedtbat, tbougb
scientihcknowledgeinvalidates qualities,wbicbitmakesappear
illusory, foralltbatitdoesnotannultbem.Quantityisqualityde-
nied, butnotqualitysuppressed. Tbe qualitative varietyof sim-
pleligbts,perceivedascolorsby tbebumaneye, isreducedby
sciencetotbequantitativedifferenceofwavelengtbs,buttbequal-
itativevarietystillpersistsintbeformofquantitativedifferences
in tbe calculation of wavelengtbs. Uegel maintains tbat, by its
growtbordiminution,quantitycbangesintoquality. Tbiswould
beperfectlyinconceivableifarelationtoqualitydidnotstillper-
sistin tbe negated qualitywbicbis calledquantity.
2 1
!romtbispointofviewiti s completelyillegitimatetomain-
taintbat tbe patbological state is really andsimplyagreateror
lesservariation oftbe pbysiological state. Litber tbis pbysiologi-
calstateis conceivedasbavingonequalityandvaluefortbe liv-
ingman,andsoitisabsurdtoextendtbatvalue,identicaltoitself
initsvariations,toastatecalledpatbologicalwbosevalueandquan-
tityaretobedifferentiatedfromandessentiallycontrastedwitb
tbe brst. Or wbat isunderstoodas tbepbysiologicalstate is a
simplesummary ofquantities,witboutbiologicalvalue,asimple
factorsystemofpbysicalandcbemicalfacts,butastbisstatebas
no vitalquality, itcannotbecalledbealtbyornormalorpbysio-
logical.Normalandpatbologicalbavenomeaningonascalewbere
tbebiologicalobjectisreducedtocolloidalequilibriaandionized
solutions. |nstudyingastatewbicbbedescribesaspbysiological,
1 1 0
IMPL ICATIONS OF A THEORY
tbe pbysiologist qualib es itassucb, evenunconsciously,becon-
siderstbisstateaspositivelyqualib edbyandfortbelivingbeing.
Nowtbisqualib edpbysiologicalstateisnot,assucb,wbatisex-
tended, identicallytoitself,toanotberstatecapableofassuming,
inexplicably, tbe quality ofmorbidity.
Of coursetbis is notto saytbatananalysisoftbeconditions
orproductsofpatbologicalfunctionswillnotgivetbecbemistor
pbysiologist numerical results comparable to tbose obtained ina
way consistent witb tbe terms of tbe same analyses concerning
tbecorresponding, so-calledpbysiologicalfunctions. butitisar-
guableastowbetbertbetermsmore andless, oncetbeyentertbe
deb nitionoftbepatbologicalasaquantitativevariationoftbenor-
mal,baveapurelyquantitativemeaning. Alsoarguableistbelog-
icalcoberenceofbernard'sprincipal.'Tbedisturbanceofanormal
mecbanism,consistinginaquantitativevariation,anexa_eration,
oranattenuation,constitutestbepatbologicalstate. Asbasbeen
pointedoutinconnectionwitbbroussais'sideas,intbeorderof
pbysiologicalfunctionsandneeds,onespeaksofmoreandlessin
relationtoanorm.!orexample,tbebydrationoftissuesisafact
wbicbcanbeexpressedintermsofmoreandless,soistbeper-
centageofcalciuminblood.Tbesequantitativelydifferentresults
wouldbavenoquality, novalueinalaboratory, iftbelaboratory
badnorelationsbipwitbabospitalorclinicwberetberesultstake
on tbe value or not of uremia, tbe value ornotof tetanus. be-
cause pbysiology stands attbecrossroads of tbelaboratoryand
tbeclinic, two points of viewaboutbiological pbenomena are
adopted tbere, but tbis does not mean tbat tbeycanbeinter-
cbanged.Tbe substitution ofquantitativeprogressionfor quali-
tativecontrastinnowayannulstbisopposition. |talwaysremains
attbebackof tbemind of tbose wbo bave cbosen toadopttbe
tbeoretical andmetrical point of view. Wbenwe saytbatbealtb
anddiseasearelinkedbyalltbeintermediaries,andwbentbiscon-
I I I
tinuityis convertedinto bomogeueity, we forget tbat tbe differ-
encecontinuestomanifestitself at tbe extreme, witboutwbicb
tbeintermediariescouldinnoway playtbeirmediatingrole,no
doubtunconsciously, butwrongly,weconfusetbeabstractcalcu-
lationof identities andtbeconcrete appreciation ofdilIerences.
I 1 2
PART T wo
Do Sciences of the Normal and
the Pathol ogical E xis t?
CHA PTER |
Introduction to th e Proble m
|tisinterestingtonotetbatintbeirowndisciplinecontemporary
psycbiatrists bave brougbt abouta rectihcationand restatement
oftbeconceptsofnormal andpathological from wbicbpbysicians
andpbysiologistsapparentlybavenotcaredtodrawalessoncon-
cerningtbemselves. |erbapstbereasonfortbisistobesougbtin
tbe usually closerrelationsbetween psycbiatry and pbilosopby
tbrougbtbeintermediaryofpsycbology. |n!rance,blondel,Lan-
ielLagacbeandLugneVinkowskiinparticularbavecontributed
toadebnitionoftbegeneralessenceoftbemorbidorabnormal
psycbicfactanditsrelations witbtbenormal. |nbisLa conscience
morbide Vorbid Consciousness( |aris,Alcan, l 9l+)], blondel de-
scribescasesofinsanitywberetbepatientsseemincomprebensi-
bletootbersaswellastotbemselves,wberetbedoctorreallybas
tbeimpressionofdealingwitbanotbermentalstructure,beseeks
tbe explanation for tbis in tbe impossible situationwberetbese
patientstranslatetbe dataof tbeircenestbesia into tbe concepts
ofnormallanguage.|tisimpossiblefortbepbysician,startingfrom
tbeaccountsofsickmen, tounderstandtbe experiencelivedby
tbe sickman, forwbatsickmen express inordinary concepts is
notdirectlytbeirexperiencebut tbeirinterpretationofanexpe-
riencefor wbicbtbeybavebeendeprivedofadequateconcepts.
1 1
5
Lagacbeisquitefarfromtbispessimism.Uetbinkstbatadis-
tinctionmustbemadeintbeabnormalconsciousnessbetweenvari-
ationsofnatureandvariationsofdegree,incertainpsycbosestbe
patient'spersonalityisbeterogenous witbtbeformerpersonality,
inotbers,one is tbeextension of tbeotber. Alongwitb ]aspers,
Lagacbedistinguisbesincomprebensiblepsycbosesfromcompre-
bensibleones,intbelattercasetbepsycbosisseemstobeintelli-
giblyrelatedtotbeearlierpsycbiclife.Uence,asidenomdifhculties
posed by tbegeneral problem of understanding otbers, psycbo-
patbology is a source of documents wbicb can be utilized in
generalpsycbology, a sourceofligbttobesbedonnormalcon-
sciousness [66, . 0]. but andtbis istbe pointwe want to
make tbis position is quite differentfromRibot'smentioned
above. Lisease, according to Ribot, is a spontaneous andmetb-
odological substitute for experimentation, reacbes tbeunreacb-
able,butrespectstbenatureoftbenormalelementstowbicbit
reducespsycbicfunctions.Liseasedisorganizesbutdoesnottrans-
form,itreveals witbout altering. Lagacbedoesnot admittbeas-
similation of disease witb experimentation. Lxperimentation
demandsanexbaustiveanalysisoftbepbenomenon'sconditions
ofexistenceandarigorousdeterminationoftbeconditionswbicb
aremadetovaryinordertoobservetberepercussions.Onnone
oftbesepointsismentalillnesscomparablewitbexperimentation.
!irst, notbing is less well known tban tbeconditionsinwbicb
natureestablisbestbeseexperiences,tbesementalillnesses.tbebe-
ginningofapsycbosismostoftenescapestbenoticeoftbedoc-
tor,tbepatient,andtbosesurroundingbim,itspbysiopatbology,
itspatbologicalanatomyareobscure[66, . 0].Later.attbe
basisoftbeillusionwbicbassimilatestbepatbologicalmetbodin
psycbologywitbtbeexperimentalmetbod,tbereistbeatomistic
andassociationistrepresentationofmentallife,tbisistbefaculty
psycbology[ibid. ]. Astberearenoseparableelementarypsycbic
1 1 6
facts,patbologicalsymptomscannotbecomparedwitbelements
ofnormal consciousness because a symptombasa patbological
signihcanceonlyinitsclinicalcontext,wbicbexpressesaglobal
disturbance. !orexample, a verbal psycbomotorballucination is
involvedindeliriumanddeliriumisinvolved inanalteration of
tbepersonality[66, 8. 08-7]. Consequently,generalpsycbologycan
usepsycbopatbologicaldataintbesameepistemologicallyvalidway
as factsobservedin normalpeople, butnotwitbout one express
adaptationfor tbeoriginality of tbe patbological. Unlike Ribot,
Lagacbetbinkstbatmorbiddisorganizationisnottbesymmetri-
calinverseofnormalorganization. !ormscanexistinpatbologi-
calconsciousnesswbicbbavenoequivalentintbenormalstateand
yet bywbicbgeneral psycbology is enricbed.
Lventbemostbeterogeneousstructures,beyondtbeintrinsic
interestoftbeirstudy,canfurnisbdataforproblemsposedby
generalpsycbology,tbeyevenposenewproblems,andacuri-
ouspeculiarityofpsycbopatbologicalvocabularyisitsaccom-
modationofnegativeexpressionswitboutequivalentinnormal
psycbology,bowcanwefailtorecognizetbenewligbttbrown
onour knowledge of tbe buman being by ideas sucb as tbat
of discordance? [66, 8. 08-8].
Vinkowskialsotbinks tbattbefactofinsanitycannotbere-
ducedtoj usttbeonefactofdisease,determinedbyitsreference
tooneimageorpreciseideaoftbeaverageornormalbeing.Wben
we callanotbermaninsane,wedosointuitivelyas men, notas
specialists. Tbemadmanisoutofbismindnotsomucbinre-
lationtootbermenastolife.beisnotsomucbdeviantasdilIer-
ent. Tbrougb anomalies a buman being detacbes bimselffrom
everytbingwbicbformsmenandlife. |naparticularlyradicaland
striking and tberefore primitive way tbey reveal to us tbe
1 1
7
signihcanceofanaltogetber'singular'formofbeing.Tbiscircum-
stance explainswby'beingsick'does notatallexbausttbepbe-
nomenonof insanity, wbicb,comingto ourattentionfrom tbe
perspectiveof'beingdifferent'intbequalitativesenseoftbeword,
directlyopenstbewaytopsycbopatbologicalconsiderationsmade
fromtbatperspective+, //]. AccordingtoVinkowski, insanity
orapsycbicanomalypresents itsownfeatureswbicbbebelieves
arenotcontainedintbeconceptofdisease.!irstofallinananom-
alytbereistbeprimacyoftbenegative,evilisdetacbedfromlife
wbilegoodisenmesbedwitb vital dynamismand hnds its mean-
ing only 'in a constantprogression calledtoextendeverycon-
ceptualformularelativeto tbiswould-benorm +, /]. |sn'tit
tbesameintberealmoftbebodyandtberetoodoesn'tonespeak
ofbealtbonlybecausediseasesexist?butaccordingtoVinkowski
mental illnessisamore immediately vital categorytbandisease.
somaticdiseaseiscapableofasuperiorempiricalprecision,ofa
better-debnedstandardization,somaticdisease does notrupture
tbebarmonybetweenfellowcreatures,tbesickmanisforuswbat
beis for bimself, wbereas tbe psycbicallyabnormal bas nocon-
sciousnessofbisstate. 'Tbeindividualdominatestbespbereof
mentaldeviationsmucbmoretbanbedoesintbesomaticspbere
+, /-].
We donotsbareVinkowski'sopinionontbislastpoint. Like
Lericbewe tbinktbatbealtbislife intbe silence of tbeorgans,
tbatconsequentlytbebiologicallynormal,aswebavealreadysaid,
isrevealedonlytbrougbinfractionsoftbenormandtbatconcrete
orscientihcawarenessofl existsonlytbrougbdisease.Weagree
witb>igeristtbat'diseaseisolatesl07, 6],andtbatevenif'tbis
isolationdoesnotalienatemenbutontbecontrarybrings tbem
closer to tbe sick man l 07, -], no perceptive patient can ig-
nore tbe renunciations and limitations imposed by bealtby men
inordertocomenearbim.WeagreewitbColdsteintbattbenorm
1 1 8
in patbology is above all anindividual norm+6,272]. |n sbort,
wetbinktbattoconsiderlifeasadynamicforceoftranscendence
asVinkowskidoes(wbosesympatbiesforbergsonianpbilosopby
arerevealedinworks sucbasLa schizophrenie |aris, |ayot, l9z7]
orLe temps vecu Neucbtel,LelacbauxandNiestl, l96, trans-
latedasLived Time, Lvanston,NortbwestemUniversity|ress,l970])
istoforceoneselftotreatsomaticanomalyandpsycbicanomaly
intbesameway. WbenLy,wboapprovesVinkowski'sviews,states.
Tbenormalmanisnotameancorrelativetoasocialconcept,
itisnotajudgmentofrealitybutratberajudgmentofvalue,
itisalimitingnotionwbicbdeb nes a being'smaximumpsy-
cbic capacity. Tbereis no upperlimittonormality +, -3],
wehnditsufhcienttoreplace'psycbicwitb'pbysicalinorder
toobtain averycorrectdehnitionof tbe concept of tbenormal
wbicbtbepbysiologyandmedicineoforganicdiseasesuseevery
day witbout caring enougb to state its meaning precisely.
Voreover,tbisinsouciancebasgoodreasonsbebindit,partic-
ularlyontbepartoftbepracticingpbysician.|ntbehnalanalysis
itistbe patientswbomostoften decide andfromverydiffer-
entpointsofview wbetbertbeyarenolongernormalorwbetber
tbeybavereturnedtonormality. !oramanwbosefutureisalmost
alwaysimaginedstartingfrompastexperience,becomingnormal
againmeans takingupaninterruptedactivityoratleastanactiv-
itydeemedequivalentbyindividualtastesortbesocialvaluesof
tbe milieu. Lven if tbis activityis reduced, even if tbe possible
bebaviorsarelessvaried,lesssuppletbanbefore,tbeindividualis
notalwayssoparticularasalltbat.Tbeessentialtbingistoberaised
fromanabyss of impotence orsufferingwberetbe sick mano|-
most died; tbe essential tbing isto have had a narrow escape. Take,
forexample,ayoungmanexaminedrecently,wbofellonamov-
1 1
9
ingcircularsaw,wbosearmwasdeeplycutcross-wisetbree-fourtbs
tbewayupbutwbere tbeinternalvascularnervebundlewasun-
barmed. Aquickandintelligentoperationallowedtbearmtobe
saved.Tbearmsbowsanatropbyofalltbemuscles,includingtbe
forearm.Tbewbolelimbiscold,tbebandiscyanotic.Wbenstim-
ulatedelectrically,tbegroupofextensormusclessbowsadistinctly
degeneratedreaction. Tbe movements of llexion, extension and
supinationoftbeforearmarelimited(dexion limitedto+", ex-
tensiontoaboutl 70"),pronationisnearlynormal.Tbepatientis
bappytoknowtbattbereistbepossibilitybewillrecovermucb
oftbeuseof bislimb. Certainly, witbrespecttotbeotberarm,
tbe injuredand surgicallyrestoredarm will not benormalfrom
tbetropbicandfunctionalpointofview.buton the whole tbeman
willtakeup tbetradeagainwbicbbebadcbosenorwbicbcir-
cumstances put forward, if notimposed,onwbicb, in any case,
beplacesareason evenamediocreone forliving.!romnow
on,eveniftbismanobtainsequivalenttecbnicalresultsusingdif-
ferentproceduresof complexgesticulation,sociallybewillcon-
tinuetobeappreciatedaccordingtoformernorms,bewillalways
beacartwrigbtora driver and notaformercartwrigbtorafor-
mer driver. Tbe sickmanlosessigbt of tbefacttbatbecauseof
bisinjurybewl homnowonlackawiderangeofneuromuscular
adaptations and improvisations, tbat is, tbe capacity wbicb per-
bapsbebadneverusedtobetterbisoutputandsurpassbimself,
buttbenonlybecauseoflackofopportunityTbesickmanmain-
tains tbatbe isnotinanyobvious sensedisabled. Tbis notionof
disabilit sbouldbestudiedby a medical expertwbowould not
seeintbeorganismmerelyamacbinewboseoutputmustbecal-
culated,anexpertwboisenougbofapsycbologisttoappreciate
lesionsasdeteriorationsmoretbanaspercentages. butingen-
eraltbeexpertspracticepsycbologyonlyinordertotrackdown
psycbosesofreclaimingrigbts[pschoses de revendication] intbesub-
1 20
jectspresentedtotbemandtotalkofpitbiatismmorbiditycur-
able bysuggestion]. be tbatas itmay,tbepracticingpbysicianis
veryoftenbappytoagreewitbbispatientsindehningtbenormal
and abnormal according to tbeir individual norms, except, of
course,intbecaseofgrossignoranceontbeirpartoftbemini-
malanatomicalandpbysiologicalconditionsofplantoranimallife.
Werememberbavingseeninsurgicalserviceasimple-mindedfarm-
bandbotbofwbosetibiasbadbeenfracturedbyacartwbeeland
wbombismasterbadnotbadtreatedforfearofwboknowswbat
responsibilities,tbe tibias badjoinedtogetberbytbemselves atan
obtuseangle.Tbemanbadbeensenttotbebospitalaftertbede-
nunciationbyneigbbors.|twasnecessarytorebreakbistibiasand
settbemproperly. |tiscleartbattbebeadoftbedepartmentwbo
madetbedecisionbadanotberimageoftbebumanlegtbantbat
oftbatpoor devil andbismaster. |t is also cleartbatbeadopted
anormwbicbwouldnotbavesatishedeitbera]eanbouin!rencb
Olympicrunnerinl 9l z]ora>ergeLifardancer, cboreograpber
and ballet master, |aris Opera ballet, l 910l9].
]asperssawclearlywbat difb cultieslieintbismedicaldeter-
mination of tbe normal andbealtb.
|t is tbepbysicianwbo searcbes tbeleastfor tbemeaningof
tbewords'bealtbanddisease. Ueisconcemedwitbvitalpbe-
nomenafromtbescientihcpointofview.Voretbantbepby-
sicians'judgment,itistbepatients'appraisalandtbedominant
ideas of tbe social context, wbicb determine wbat is called
'disease 9, ].
Wbatonehndsincommonintbedifferentmeaningsgiventoday
orintbepasttotbe conceptof disease istbattbeyformajudg-
mentofvirtualvalue. 'Liseaseisageneralconceptofnon-value
wbicbincludesallpossiblenegativevalues9, -].Tobesickis
1 2 1
tobebarmfulorundesirableorsociallydevalued,etc. Ontbeotber
band,fromtbepbysiologicalpointofviewwbatisdesiredinbealtb
is obvious and tbis gives tbe concept of pbysical disease a rela-
tively stablemeaning. Lesirable values are 'life, a longlife, tbe
capacityfor reproductionandforpbysicalwork,strengtb,resis-
tancetofatigue,tbeabsenceofpain,astateinwbicbonenotices
tbebodyaslittleas possibleoutsideof tbej oyoussenseof exis-
tence[59, 6]. Uowever,medicalsciencedoesnotconsistinspec-
ulatingabouttbesecommonconceptsinordertoobtainageneral
conceptofdisease,itsrealtaskistodeterminewbataretbevital
pbenomenawitbregardtowbicbmencalltbemselvessick,wbat
aretbeirorigins,tbeirlawsofevolution,tbeactionswbicbmod-
ifytbem.Tbegeneralconceptofvalueisspecihedinamultitude
ofconceptsofexistence.butdespitetbeapparentdisappearance
ofanyvaluej udgmentintbeseempiricalconcepts, tbepbysician
persists in talking of diseases, because medicalactivity, tbrougb
clinicalquestioningandtberapeutics, basarelationsbipwitbtbe
patient and bis valuej udgments [ 59, 6].
|tisperfectlyunderstandable, tben,tbatpbysiciansarenotin-
terestedina conceptwbicbseems to tbem to be too vulgaror
toometapbysical. Wbatinterests tbem is diagnosis and cure. |n
principle,curingmeansrestoringafunctionoranorganismtotbe
normfromwbicbtbeybavedeviated.Tbepbysicianusuallytakes
tbenormfrombisknowledgeof pbysiology calledtbescience
oftbenormalman frombisactualexperienceoforganicfunc-
tions,andfromtbecommonrepresentationoftbenorminaso-
cialmilieuatagivenmoment.Oftbetbreeautborities,pbysiology
carriesbimfurtbest.Vodernpbysiologyispresentedasacanoni-
calcollectionoffunctionalconstantsrelatedtotbebormonaland
nervousfunctionsofregulation.Tbeseconstantsaretermednor-
malinsofarastbeydesignateaveragecbaracteristics,wbicbaremost
frequentlypracticallyobservable. buttbeyare alsotermednor-
1 2 2
malbecausetbeyenterideallyintotbatnormativeactivitycalled
tberapeutics. |bysiologicalconstants are tbusnormalintbe sta-
tisticalsense,wbicbisadescriptivesense,andintbetberapeutic
sense, wbicbisanormativesense. buttbequestioniswbetberit
ismedicinewbicbconverts and bow? descriptiveand purely
tbeoretical concepts into biological ideals or wbetbermedicine,
inadmittingtbenotionoffactsandcoustantfunctionalcoefhcients
frompbysiologywouldnotalsoadmit probablyunbeknownstto
tbepbysiologists tbenotionofnormintbenormativesense of
tbeword.Anditisaquestionofwbetbermedicine, indoingtbis,
wouldn'ttakebackfrompbysiologywbatititselfbadgiven.This
is tbe difhcultproblem to examine now.
CHAPTER ||
A Crit ical E xaminat ion of Cert ain
C once
p
t s : T he N ormal, Anomal
y
and
Diseas e; T he N ormal and
t he E x
p
erimental
Littr andRobin'sDictionnaire de medecine deb nes tbenormal as
follows.normal(normalis, fromnorma, rule).tbatwbicbconforms
totbe rule, regular. Tbebrevityoftbisentryinamedicaldictio-
narydoesnotsurpriseusgiventbeobservationswebavejustmade.
Lalande's Vocabulaire techni
que et critique de la philosophie ismore
explicit. >incenorma, etymologically,meansaT-square,normalis
tbatwbicbbends neitber totberigbtnorleft, bence tbatwbicb
remains in a bappy medium, from wbicb two meanings are de-
rived.( l ) normalistbatwbicbissucbtbatitougbttobe,(z)nor-
mal, intbemost usual sense oftbeword,istbatwbicbismetwitb
intbemajorityofcasesofadeterminedkind,ortbatwbicbcon-
stituteseitbertbeaverageorstandardofameasurablecbaracter-
istic. |ntbediscussionof tbesemeaningsitbasbeen pointedout
bowambiguoustbistermissinceitdesignatesatonceafactand
'avalueattributedtotbisfactbytbepersonspeaking, byvirtue
ofanevaluativejudgmentforwbicbbetakesresponsibility. One
sbouldalso stress bow tbisambiguityisdeepenedbytbe realist
pbilosopbicaltraditionwbicbboldstbat,aseverygeneralityistbe
signofanessence,andeveryperfectiontberealizationoftbees-
sence, agenerality observable in fact takestbevalue of realized
perfection,andacommoncbaracteristic,tbevalueofanidealtype.
1 2
5
!inally,ananalogousconfusioninmedicinesbouldbeempbasized,
wberetbenormalstatedesignatesbotbtbebabitualstateof tbe
organs,andtbeirideal,sincetbereestablisbmentoftbisbabitual
ideal istbe ordinary aim of tberapeutics [67].
| tseemstoustbattbislastremarkbasnotbeendevelopedas
itsbouldbeandtbat,inparticular,intbeentrycited,notenougb
bas been deduced from it concerning tbeambiguityofmeaning
intbetermnormal wbereoneisbappytopointoutitsexistence
ratbertbanseeinitaproblemtosolve.|tistruetbatinmedicine
tbenormalstateoftbebumanbodyistbestateonewantstore-
establisb.butisitbecausetberapeuticsaimsattbisstateasagood
goal to obtain tbatitis called normal, orisitbecause tbe inter-
estedparty, tbatis, tbe sickman, considers itnormaltbattbera-
peutics aim at it?Weboldtbe second statement tobetrue. We
tbinktbatmedicineexistsas tbeartof lifebecausetbelivingbuman
beingbimselfcallscertaindreadedstatesorbebaviorspatbologi-
cal(bencerequiringavoidanceorcorrection)relative to tbe dy-
namicpolarityof life, intbeform ofanegativevalue.Wetbink
tbatindoingtbistbelivingbumanbeing,inamoreorlesslucid
way,extendsaspontaneouseffort,peculiartolife,tostru_leagainst
tbat wbicb obstructs its preservation and development taken as
norms.TbeentryintbeVocabulaire philosophique seemstoassume
tbatvaluecanbeattributedtoabiologicalfactonlyby'bimwbo
speaks, obviouslyaman. We,ontbeotberband,tbinktbattbe
facttbatalivingmanreactstoalesion,infection,functionalan-
arcbybymeansofadisease,expressestbefundamentalfacttbat
lifeisnotindifferenttotbeconditionsinwbicbitispossible,tbat
lifeispolarityandtberebyevenanunconsciouspositionofvalue,
insbort,lifeisinfactanormativeactivity. Normative, inpbiloso-
pby, meanseveryjudgmentwbicbevaluatesorqualib es afactin
relationtoanorm,buttbismodeofjudgmentisessentiallysub-
ordinatetotbatwbicbestablisbesnorms.Normative,intbefull-
1 26
A CRITICAL EXAMINATION OF CERTAIN CONCEPTS
estsenseoftbeword, istbatwbicbestablisbesnorms. Anditi s
intbissensetbatweplantotalkaboutbiologicalnormativity. We
tbinktbat we are as careful as anyone asfar as tbe tendency to
fall into antbropomorpbism is concerned. We do not ascribe
a buman content to vital norms butwe do askourselves bow
normativityessentialtobumanconsciousnesswouldbeexplained
ifitdidnotinsomewayexistinembryoinlife.Weaskourselves
bowabumanneedfortberapeuticswouldbaveengenderedamed-
icine wbicbisincreasinglyclairvoyant witbregardtotbe condi-
tionsofdiseaseiflife'sstruggleagainsttbeinnumerabledangers
tbreateningitwerenotapermanentandessentialvitalneed. !rom
tbe sociological pointof view it can besbown tbat tberapeutics
washrstareligious,magicalactivity, buttbisdoesnotnegatetbe
facttbattberapeuticneedisavitalneed,wbicb,eveninlowerliv-
ing organisms (witbrespecttovertebratestructure) arouses re-
actionsofbedonicvalueorself-bealingorself-restoringbebaviors.
Tbe dynamic polarityoflifeandtbenormativityitexpresses
accountforanepistemologicalfactofwboseimportantsignihcance
bicbatwasfullyaware.biologicalpatbologyexistsbuttbereisno
pbysical orcbemical ormecbanical patbology.
Tbere are two tbings in tbe pbenomena of life. ( l ) tbe state
ofbealtb,( z) tbestateof disease,andfromtbesetwodistinct
sciencesderive.pbysiology,wbicbconcernsitselfwitbtbepbe-
nomenaoftbehrststate,patbology, witbtboseoftbesecond.
Tbebistoryofpbenomenainwbicbvitalforcesbavetbeirnat-
uralformleadsus,consequently,totbebistoryofpbenomena
wberetbeseforcesarecbanged.Now,intbepbysicalsciences
onlytbehrstbistoryexists,nevertbesecond.|bysiologyisto
tbemovementoflivingbodieswbatastronomy,dynamics,by-
draulics,bydrostatics,etc. aretoinertones. tbeselastbaveno
scienceatallwbicbcorrespondstotbemaspatbologycorres-
1 2
7
pondstotbehrst.!ortbesamereasontbewboleideaofmed-
icationisdistasteful to tbe pbysicalsciences.Anymedication
aimsatrestoringcertainpropertiestotbeirnaturaltype.aspbys-
icalpropertiesneverlosetbistype,tbeydonot needtobere-
stored to it. Notbing intbe pbysical sciences corresponds to
wbatistberapeuticsintbepbysiologicalsciences l 1,I, 20-21 ].
|t is clear from tbis text tbat natural type must be taken in tbe
senseofnormaltype.!orbicbattbenatural isnottbeeffectofa
determinism,buttbetermofahnality. Andweknowwell every-
tbing tbat canbefoundwrong insucba text from tbe point of
viewofamecbanistormaterialistbiology. Onemigbtsaytbatlong
agoAristotlebelievedinapatbologicalmecbanicssincebeadmit-
tedtwo kinds ofmovements. natural movements tbrougbwbicb
abodyregainsitsproperplacewbereittbrivesatrest,asastone
goesdownto tbeground,andhre, up to tbe sky, and violent
movements by wbicba bodyis pusbedfrom itsproperplace,as
wbenastoneistbrownintbeair. |tcanbesaidtbatwitbCalileo
andLescartes,progressinknowledgeoftbepbysicalworldcon-
sistedinconsideringallmovementsasnatural,tbatis,asconform-
ingtotbelawsofnature,andtbatlikewiseprogressinbiological
knowledgeconsistedinuni[ingtbelawsofnaturallifeandpatbo-
logicallife. |tisprecisely tbis unihcation wbicbComtedreamed
ofandClaudebernarddatteredbimselfwitbbavingaccomplisbed,
as was seen above. Totbe reservations wbicbwe feltobliged to
setfortbattbat time, let usaddtbis. |n establisbingtbescience
ofmovementontbeprincipleofinertia,modernmecbanicsinef-
fectmade tbe distinctionbetweennaturalandviolentmovements
absurd, as inertia ispreciselyanindifferencewitb respect to di-
rectionsandvariationsinmovement. Lifeisfarremovedfromsucb
anindifferencetotbeconditionswbicbaremadeforit,lifeispo-
larity. Tbe simplestbiologicalnutritivesystemof assimilationand
1 28
excretionexpressesapolarity. Wben tbe wastes of digestionare
nolongerexcretedbytbeorganismandcongestorpoisontbein-
ternalenvironment, tbis isall indeed according tolaw(pbysical,
cbemical, etc. )but noneof tbis follows tbe norm, wbicbis tbe
activityoftbeorganismitself.Tbisistbesimplefacttbatwewant
topointoutwben we speakof biological normativity.
Tberearesome tbinkerswboseborrorofhnalismleads tbem
torejecteventbeLarwinian ideaofselectionbytbeenvironment
andstruggleforexistencebecauseofbotbtbetermselection, ob-
viously ofbumanand tecbnological import, andtbeideaof ad-
vantagewbicbcomes into tbe explanationof tbemecbanismof
naturalselection.Tbeypointouttbatmostlivingbeingsarekilled
bytbeenvironmentlong before tbe inequalitieswbicbtbeycan
produceevenbaveacbancetobeofusetotbembecauseitkills
aboveallsprouts,embryosortbeyoung.butasCeorgesTeissier
observed,tbefacttbatmanyorganismsdiebeforetbeirinequali-
tiesservetbemdoesnotmeantbattbepresentationofinequali-
tiesisbiologicallyi ndifferent[ 1 1 1 ]. Tbisispreciselytbeonefact
weasktobegranted.Tbereisnobiologicalindifference,andcon-
sequentlywecanspeakofbiologicalnormativityTberearebealtby
biological norms and tbere arepatbological norms, and tbesec-
ondare nottbesameas tbe hrst.
Wedidnotrefer totbe tbeory ofnatural selectionuninten-
tionally. We wanttodrawattentiontotbefacttbatwbatistrue
of tbeexpressionnatural selection isalsotrueoftbeoldexpres-
sionvis medicatrix naturae. >election andmedicine are biological
tecbniques practiceddeliberatelyandmore orless rationally by
man.Wbenwespeakofnaturalselectionornaturalmedicinalac-
tivitywearevictimsofwbatbergsoncallstbeillusionofretro-
activity ifwe imaginetbatvitalprebumanactivity pursuesgoals
andutilizesmeanscomparabletotboseofmen.butitisonetbing
totbinktbatnaturalselectionwouldutilizeanytbingtbatresem-
bles pedigrees, and vis medicatrix, cuppingglasses, andanotber to
tbinktbatbumantecbniqueextendsvitalimpulses,atwboseserv-
iceittriestoplacesystematicknowledgewbicbwoulddelivertbem
from mucb of life's costly trial and error.
Tbeexpressions'naturalselectionand'naturalmedicinalac-
tivitybaveonedrawbackintbattbeyseemtosetvitaltecbniques
witbintbeframeworkofbumantecbniqueswbenitistbeoppo-
sitewbicbseemstrue.Allbumantecbnique,includingtbatoflife,
issetwitbinlife,tbatis,witbinanactivityofinformationandas-
similationofmaterial. | tisnotbecausebumantecbniqueisnor-
mativetbatvitaltecbniqueisjudgedsucbbycomparison. because
lifeisactivityofinformationandassimilationitistberootofall
tecbnicalactivity. |nsbort,we speakofnaturalmedicineinquite
aretroactiveand,inonesense,mistakenway, butevenifwewere
toassumetbatwebavenorigbttospeakofit,wearestillfreeto
tbinktbatnolivingbeingwouldbaveeverdevelopedmedicaltecb-
niqueiftbelife witbinbim as witbin everylivingtbing were
indifferenttotbeconditionsitmet witb, iflifewerenotaform
ofreactivitypolarizedtotbevariationsoftbeenvironmentinwbicb
itdevelops. Tbis was seenvery well by Cuynot.
|t is a fact tbat tbeorganismbas an aggregate of properties
wbicbbelongtoitalone,tbankstowbicbitwitbstandsmulti-
pledestructiveforces. Witbouttbesedefensivereactions,life
would berapidlyextinguisbed... . Tbelivingbeingis able to
bndinstantaneouslytbereactionwbicbisusefulvis--vissub-
stanceswitbwbicbneitberitnoritskindbaseverbadcontact.
Tbeorganismisanincomparablecbemist. |tistbehrstamong
pbysicians.Tbelluctuationsoftbeenvironmentarealmostal-
waysamenacetoitsexistence.Tbelivingbeingcouldnotsur-
vivei itdidnotpossesscertainessentialproperties.Lveryinjury
A CRITICAL EXAMINATI ON OF CERTAIN CONCEPTS
would befatal if tissueswere incapableof forming scars and
blood incapable of clotting z, t 6].
byway ofsummary, wetbink itvery instructivetoconsider
tbe meaning tbat tbe word 'normal assumes in medicine, and
tbe facttbattbe concept's ambiguity, pointedoutby Lalande, is
greatlyclarihedby tbis,witba quitegeneral signihcancefortbe
problemoftbenormal. |tislife itselfandnotmedicaljudgment
wbicbmakes tbebiologicalnormalaconceptof valueandnota
conceptofstatisticalreality. !ortbepbysician,life isnotanob-
jectbutratbera polarized activity, wbosespontaneous effortof
defenseandstru_leagainstalltbatisofnegativevalueisextended
bymedicinebybringingtobeartberelativebutindispensableligbt
of buman science.
Lalande's Vocabulaire philosophique contains animportant remark
abouttbetermsanomaly andabnormal. Anomaly isasubstantivewitb
nocorrespondingadjectiveatpresent,abnormal, ontbeotberband,
isanadjectivewitbnosubstantive,sotbat!rencb]usagebascou-
pledtbem,makingabnormaltbeadjectiveofanomaly. |tisquite
true tbat 'anomalous [anomal], wbicb |sidore Ceoffroy >aint-
Uilaire was still using in 1 8 36 in bisHistoire des anomalies de
J'orBanisation andwbicbalsoappearsinLittrandRobin'sDiction
naire de medecine, basfallenintodisuse. Lalande'sVocabulaire sbows
tbatconfusionofanetymologicalnaturebasbelpeddrawanom-
alyandabnormalclosertogetber.'AnomalycomesnomtbeCreek
anomalia wbicbmeans unevenness,asperity,omalos inCreekmeans
tbatwbicbislevel,even,smootb,bence'anoma|y is, etymolog-
ically,an-omalos, tbatwbicbisuneven,rougb,irregular,intbesense
giventbesewordswbenspeakingofaterrain. Amistakeisoften
1
3
1
madewitbtbeetymologyof 'anomaly, byderivingitnotfrom
omalos but fromnomos wbicbmeanslaw, bence tbe compound
a-nomos. TbisetymologicalerrorisfoundrigbtinLittrandRob-
in'sDictionnaire de medecine. TbeCreeknomos andtbeLatinnorma
bavecloselyrelatedmeanings,lawandruletendingtobecomecon-
fused. Uence, ina strictly semantic sense 'anomaly points toa
fact, and is a descriptive term, wbile 'abnormal implies refer-
encetoavalueandisanevaluative,normative term,buttbeswitcb-
ingofgoodgrammatical metbods bas meant a confusionof tbe
respective meanings of anomalyandabnormal. 'Abnormal bas
become a descriptive concept and 'anomaly, a normative one.
Ceoffroy>aint-Uilaire,wbomakestbeetymologicalerror,repeated
afterbimbyLittrandRobin,triestomaintaintbepurelydescrip-
tiveandtbeoreticalmeaningof 'anomaly, wbicb isabiological
factandmustbetreatedassucb,tbatis,itmustbeexplained,not
evaluated, by natural science.
Tbe wordanomal liketbewordirregularit, mustneverbetaken
intbesensewbicb wouldbededucedliterallyfromitsetymo-
logicalcomposition.Tberearenoorganicformationswbicbare
notsubjecttolaws,andtbeworddisorder, takeninitsrealsense,
wouldnotbe applicable toanyproductions ofnature. 'Ano-
malyisanexpressionwbicbbasbeenrecentlyintroducedinto
anatomical language, wbose use tbere iseven infrequent. On
tbe otber band, tbe zoologists from wbom itwas borrowed,
use itveryoften, tbey apply itto alarge number of animals,
wbo, because of tbeirunusual organizationandfeatures, hnd
tbemselvesisolated,sotospeak,intbeseriesandbaveonlyvery
distantkinsbipwitbotbers in tbe same class+1, I, 96, 3 7].
AccordingtoCeoffroy >aint-Uilaire,itis wrong tospeakofei-
tber peculiarities ofnature, ordisorderorirregularitywitbre-
1
3
2
gardtosucb animals. |f tbereisanexception,itistotbelawsof
naturalists,nottotbelawsof nature,forinnatureallspeciesare
what they must be, equally presenting variety in unity and unity
invariety[43, I, 37]. |nanatomytbeterm'anomalymuststrictly
maintainitsmeaning ofunusual, unaccustomed; tobeanomalous is
toberemoved,intermsofone'sorganization,fromtbevastma-
jorityof beingstowbicb onemustbe compared [ibid. ].
Uavingdehnedanomalyingeneralfromtbemorpbologicalpoint
of view, Ceoffroy >aint-Uilairerelates itdirectlytotwobiologi-
calfacts,the specifc tpe andindividual variation. Ontbeoneband,
alllivingspeciespresentforexaminationamultitudeofvariations
intbeformandproportionalvolumeoforgans,ontbeotberband,
tbereisacomplexoftraits 'commontotbevastmajorityof in-
dividuals wbo compose a species andtbis complex deb nes tbe
specib c type. 'Lvery deviationof tbespecihc type, orinotber
words,everyorganicparticularityintroducedbyanindividualwben
comparedwitbtbevastmajorityoftbeindividualsofbisspecies,
age,andsex,constituteswbatcanbecalledanAnomaly[43, I,
30]. |t is cleartbat, so deb ned, anomalyis,generallyspeaking, a
purelyempirical or descriptive concept, a statistical deviation.
Oneproblemwbicbimmediatelypresentsitselfiswbetbertbe
conceptsanomalyandmonstrositymustbeconsideredequivalent.
Ceoffroy >aint-Uilaire ison tbe side of distinction. monstrosity
isonespeciesoftbegenusanomaly.Wbencetbedivisionofanom-
alies into Varieties, Structural defects, Heterotaxy andMonstrosities.
Varieties aresimple,sligbtanomalieswbicbdonotobstructtbeper-
formance of anyfunctionandproduceno deformity,forexam-
ple. a supernumerary muscle, anddoublerenal artery. Structural
defects aresimpleanomalies, sligbtintermsoftbeanatomicalre-
lationsbip,buttbeymaketbeperformanceofoneormorefunc-
tionsimpossibleorproduceadeformity,forexample,adefective
anus, bypospadias or barelip. Heterotaxies , a term created by
1
3 3
Ceoffroy>aint-Uilaire,are complex anomalies,seriousinappear-
anceintermsoftbeanatomicalrelationsbip,buttbeyimpede no
functionandarenotapparentontbeoutside,tbemost remark-
able, tbougb rare, example, accordingto Ceoffroy >aint-Uilaire,
is tbecompletetransposition of tbevisceraorsitus inversus. We
knowtbat,wbilerare,tbebearton tberigbt-bandsideis no mytb.
!inally,Monstrosities areverycomplexanomalies,veryserious,mak-
ing tbe performance of one or more functions impossible or
difbcult,orproducingintbeindividualssoaffectedadefectinstruc-
tureverydifferentfromtbatordinarilyfoundintbeirspecies, for
example, ectromelia or cyclopia [43, I, 33, 3-4-].
Tbeinterestofsucbaclassihcationliesintbefacttbatituti-
lizestwodifferentprinciplesofdiscriminationandbierarcby.anom-
aliesare arranged in terms of tbeirincreasingcomplexityand
increasing seriousness. Tbe simplicitycomplexity relationsbip is
purelyobj ective. |tgoes witboutsayingtbat a cervical rib isa
simpleranomalytbanectromelia orbermapbroditism. Tbesligbt
seriousrelationsbipbasaless clear-cutlogicalcbaracter. Undoubt-
edlytbegravityof anomalies isananatomicalfact,tbecriterion
oftbeanomaly'sgravityliesintbeimportance oftbeorganas far
as itspbysiologicaloranatomicalconnections are concerned[43,
I, 4-]. !ortbenaturalistimportancei sanobjectiveidea,butiti s
essentiallya subjective oneintbe sense tbat itincludes a refer-
encetotbelifeofalivingbeing,consideredbttoqualifytbissame
life according to wbat belps orbinders it. Tbis is sotrue tbat
Ceoffroy >aint-Uilaireaddedatbirdprincipleofclassihcation(a
pbysiological one) to tbe hrsttwo(complexity, gravity), tbatis,
tbe relationsbipbetween anatomy and tbe exercise of functions
(obstacle),andtbenafourtb,wbicbispatentlypsycbological,tbe
introductionoftbeideaofaharmful ordisturbing inlluenceontbe
exerciseoffunctions[43, |, 3, 3-, 4i , 4-]. |foneweretempted
1
3
4
to accord tbis last principle only asubordinate role, let us reply
tbattbecaseofbeterotaxiesempbasizesontbecontrarybotbits
precisemeaningandconsiderablebiologicalvalue.Ceoffroy >aint-
Uilaire createdtbis term todesignatemodihcationsintbeinner
organization,tbatis,intberelationsoftbeviscerawitboutmodih-
cationoftbefunctionsandexternalappearance. Untiltbentbese
cases bad not been studiedmucb and constitutedagap in ana-
tomical language. Tbis sbould not be surprising, altbougbit is
difhcultto imagine tbe possibilityof a complex anomaly wbicb
notonlydoesnotobstructtbe smallestfunctionbutalsodoesnot
even produce tbe sligbtest deformity. 'An individual affectedby
beterotaxycan enjoyveryrobust bealtb, be can live averylong
time,andoftenitisonlyafterbisdeatbtbattbepresenceofanom-
alyisnoticed,ofwbicbbebimselfbadbeenunaware[43, I, 45,
46]. Tbis amounts to saying tbat tbe anomaly is ignored insofar
astbereisnomanifestationofitintbeorderofvitalvalues.Tbus,
even a scientistacknowledges tbat an anomaly isknownto sci-
enceonlyifitishrstperceivedintbeconsciousness,intbeform
ofanobstacletotbe performanceoffunctions,ordiscomfortor
barmfulness. buttbe sensationof obstacle,discomfort orbarm-
fulnessisasensationwbicbmustbetermednormativesinceitin-
volvestbeevenunconsciousreferencetoafunctionandtoanim-
pulsetotbecompletenessoftbeirexercise. !inally, inordertobe
abletospeakofananomalyusingscientihclanguage,abeingmust
baveappearedtobimselfortoanotberasabnormalintbealbeit
unformulatedlanguageof tbeliving. Aslongastbeanomalybas
nofunctionalrepercussionsexperiencedconsciouslybytbeindi-
vidual, intbecaseof man, orascribedtolife'sdynamicpolarity
ineveryotberlivingtbing, tbeanomalyiseitberignored(intbe
caseofbeterotaxies)orconstitutesanindifferentvariet, avaria-
tiononaspecihctbeme,itisanirregularityliketbenegligibleir-
1
3
5
regularitiesfoundinobjectscastintbesame mold. |tmigbtform
tbe subj ect of a special cbapter in natural bistory, butnoti n
patbology.
On tbeotberband, if we assumetbattbebistoryof anoma-
lies andteratologyare a necessary cbapterin tbe biological sci-
ences, expressing tbe originality of tbese sciences for tbereis
nospecialscienceofcbemicalorpbysicalanomalies itisbecause
anewpointofviewcanappearinbiologyandcarveoutnewter-
ritorytbere. Tbis point of viewistbatof vitalnormativit. Lven
foran amoeba, livingmeanspreferenceand exclusion. A diges-
tivetract,sexualorgans,constituteanorganism'sbebavioralnorms.
|sycboanalytic language isindeedrigbttogive tbe namepoles to
tbe natural orihces of ingestion and excretion. A function does
notworkindifferentlyinseveral directions. A needplaces tbe
proposed obj ects of satisfaction in relation to propulsion and
repulsion.Tbereisadynamicpolarityoflife.Aslongastbemor-
pbologicalorfunctionalvariationsontbespecihctypedonotbin-
derorsubverttbispolarity,tbeanomalyisatoleratedfact,intbe
oppositecasetbeanomalyisfeltasbavingnegativevitalvalueand
isexpressedassucbontbeoutside. because tbereareanomalies
wbicbareexperiencedorrevealedasanorganicdisease,tbereex-
istshrstanaffectiveandtbenatbeoreticalinterestintbem. |tis
because tbe anomaly bas become patbological tbat itstimulates
scientihcstudyTbescientist,hombisobjectivepointofview,wants
to see tbe anomalyas a mere statisticaldivergence, ignoring tbe
fact tbat tbe biologist's scientihc interestwas stimulatedby tbe
normativedivergence. |nsbort,notallanomaliesarepatbological
butonlytbeexistenceofpatbologicalanomaliesbasgivenriseto
a special scienceof anomalies wbicb, because it is science, nor-
mallytendstoridtbedehnitionofanomalyofeveryimplication
of anormativeidea. >tatisticaldivergencessucbassimplevarie-
ties are not wbatone tbinks of wben one speaks of anomalies,
1
3
6
A .CRITICAL EXAMINATION OF CERTAIN CONCEPTS
insteadone tbinks of barmful deformitiesor tbose even incom-
patiblewitblife,as one refers to tbelivingform orbebaviorof
tbelivingbeingnotasastatisticalfactbutasanormativetypeof
life.
An anomalyisa factof individual variation wbicb prevents two
beingsfrombeingabletotaketbeplaceofeacbotbercompletely.
|tillustratestbeLeibnizeanprincipleofindiscerniblesintbebio-
logicalorder.butdiversityisnotdisease,tbeanomalous isnottbe
patbological. |atbologicalimpliespathos, tbedirectandconcrete
feelingofsufferingandimpotence,tbefeelingoflifegonewrong.
buttbepatbologicalisindeedabnormal. Rabauddistinguisbesbe-
tweenabnormalandsickbecause,followingrecent,incorrectusage,
bemakes 'abnormal tbeadjectiveof 'anomaly andintbissense
speaksofabnormalsickpeople97, 4 i ],butasbedistinguisbes
veryclearlyinotberrespectsbetweendiseaseandanomaly97, 4//],
followingtbecriteriongivenfor adaptationandviability, we see
no reasonto modify our distinctions ofwordsandmeanings.
Witboutdoubttbereisonewaytoconsidertbepatbological
normal,andtbatisbydehningnormalandabnormalintermsof
relativestatisticalfrequency. |nasenseonecouldsaytbatcontin-
ualperfectbealtbisabnormal.buttbatisbecausetbeword'bealtb
bas two meanings. Uealtb, taken absolutely, is a normative con-
ceptdehninganidealtypeoforganicstructureandbebavior,in
tbissenseitisapleonasmtospeakofgoodbealtbbecausebealtb
isorganic well-being. Qualihed bealtb isa descriptive concept,
dehninganindividualorganism'sparticulardispositionandreac-
tionwitbregardtopossiblediseases.Tbetwocoucepts, qualihed
descriptiveandabsolutenormative,aresocompletelydistincttbat
tbesamepeoplewillsayoftbeirneigbbortbatbebaspoorbealtb
ortbat be is notbealtby, considering tbe presence of a fact tbe
1
37
sameastbeabsenceofavalue. Wbenwesaytbatcontinuallyper-
fectbealtbisabnormal,weareexpressingtbefacttbattbeexpe-
rience of tbe living indeed includes disease. Abnormalmeans
preciselynonexistent,inobservable. Uenceitisonlyanotberway
of saying tbat continual bealtb is a norm and tbat a norm does
notexist.|ntbismisconstruedsense,itisobvioustbattbepatbo-
logicalisnotabnormal.Tbisissolittletruetbatwecanspeakof
tbenormalfunctionsoforganicdefenseandstruggleagainstdis-
ease.Aswebaveseen,Lericbeassertstbatpainisnotinnature's
plan, but we could say tbat disease is foreseen by tbe organism
(>endrail l 06). Witbregardtotbeantibodieswbicbareadefen
sivereactionagainstapatbologicalinoculation, ]ulesbordettbinks
tbat one can speak of normal antibodies wbicb exist in normal
serumactingelectivelyon microbe andantigen, wbosemultiple
specihcitiesbelpassuretbeconstancyoftbeorganism'scbemical
cbaractetisticsbyeliminatingtbatwbicbis not compatible witb
tbem l , 6. 1 6-1 4]. but altbougb disease may appear as fore-
seen,itisnonetbelesstruetbatitislikeastateagainstwbicbitis
necessarytostruggleinordertobeabletogoonliving,tbatis,it
islikeanabnormalstateintermsoftbepersistenceoflifewbicb
bereservesasanorm. Uenceintakingtbeword'normalinits
autbenticsensewemustsetupanequationbetweentbeconcepts
of sick, patbological and abnormal.
Anotberreasonfor avoidingconfusionbetweenanomalyand
diseaseistbatbumanattentionisnotsensitizedtoeacbasbeing
divergencesoftbesamekind.Ananomalymanifestsitselfinspa-
tialmultiplicity, disease, incbronologicalsuccession. |tisacbar-
acteristicofdiseasetbatitinterruptsacourse,infactitiscritical.
Lvenwbentbe diseasebecomescbronic,afterbavingbeencriti-
cal,tbereisapastforwbicbtbepatientortbosearoundbimre-
mainnostalgic. Uencewearesickinrelationnotonlyto otbers
butalso toourselves. Tbis istbecasewitbpneumonia, arteritis,
1
3
8
sciatica,apbasia,nepbritis,etc.|tistbecbaracteristicofananom-
alytbatitisconstitutional,congenital,evenifitsappearanceisde-
layed witb respect to birtb and is contemporary onlywitb tbe
performanceofafunction forexample,intbecongenitaldislo-
cationoftbebip.Tbepersonwitbananomalycannottbenbecom-
paredtobimself |t couldbepointedoutberetbattbeteratogenic
interpretation ofteratologicalcbaracteristics,andbetteryettbeir
teratogenetic explanation, allowtbeplacementof tbeanomaly's
appearanceinembryologicaldevelopmentandgiveittbesignih-
cance of a di sease. Once tbe eti ology and patbology of an
anomalyareknown,tbeanomalousbecomespatbological.Lxperi-
mentalteratogenesisprovidessomeusefulinsigbtsbere[ 1 20]. but
if tbisconversionof ananomalyintodiseasemakessenseintbe
scienceofembryology, itmakesnosensefortbelivingbeingwbose
bebaviorintbeenvironment,outsideoftbeeggoruterus,ishxed
at tbe outset by its structural cbaracteristics.
Wbenananomalyisinterpretedintermsofitseffectsinrela-
tion to tbe individual's activity andbenceto tbe representation
wbicbdevelopsfromitsvalueanddestiny, ananomalyisaninfrmit.
|nhrmityisavulgarbutinstructivenotion. Oneisbornoronebe-
comesinhrm.|tistbefactofbecominginhrmwbicb,interpreted
as an irremediable breakdown, bas repercussions for tbe fact of
beingborntbatway. !oraninvalidtbereexistsintbeendtbepos-
sibilityofsomeactivityandanbonorablesocialrole.butabuman
being'sforcedlimitation to a unique and invariable condition is
judgedpejorativelyintermsoftbenormal bumanideal,wbicbis
tbepotential and deliberateadaptationtoevery conditionimag-
inable. |tistbepossibleabuseofbealtbwbicb lies attbebottom
of tbe value accorded to bealtbj ustas itis tbe abuse of power
wbicb,accordingto\alry, liesattbebottomoftbeloveofpower.
Normalman isnormativeman, tbe beingcapableof establisbing
new,evenorganicnorms.Asinglenorminlifeisfeltprivately,not
1
3
9
positively. A man wbo cannot runfeels injured, tbat is,be con-
vertsbis injuryinto frustration, andaltbougbtbosearoundbim
avoidtbrowinguptobimtbeimageofbisincapacity,j ustassen-
sitivecbildrenavoidrunningwbenalamecbildiswitbtbem,tbe
invalidfeelssensitivelybywbatrestraintandavoidanceontbepart
ofbisfellowseacbdifferencebetweenbimandtbemisapparently
cancelled out.
Wbatboldstrueforinhrmityalsoboldstrueforcertainstates
of fagilit anddebilit, linkedtoatypeofpbysiologicaldivergence.
Tbisistbecasewitbhemophilia, wbicbismoreananomalytbana
disease. Alloftbebemopbiliac'smnctionsarecarriedoutliketbose
of bealtby individuals. but tbe bemorrbages areinterminable,as
iftbebloodwereindilIerenttoitssituationinsideoroutsidetbe
vessels. |nsbort, tbe bemopbiliac's life would benormalif ani-
mallifedidnotnormallyinvolverelationswitbanenvironment,
relationswboserisksintbeform of injuriesmustbemetbytbe
animalinordertocompensatefortbedisadvantagesinfeedingde-
rivedfrom tbe break witb tbe inactive, vegetarian life, a break
wbicb,inotberrespects,particularlyintermsoftbedevelopment
ofconsciousness, constitutes realprogress. Uemopbiliaisa kind
ofanomalywitbapossiblepatbologicalcbaracterbecauseoftbe
obstaclemetberebyanessentialvitalfunction,tbestrictsepara-
tionofinteriorandexteriorenvironment.
bywayofsummap.ananomalycansbadeintodiseasebutdoes
notinitself constitute one. |t is not easy to determine atwbat
momentananomalyturns intodisease. Vusttbesacralizationof
tbehftblumbarvertebrabeconsideredapatbologicalfactornot?
Tberearecertainlydegrees of tbismalformation. Onlytbehftb
vertebramustbetermedsacralizedwbenit isfusedwitb tbe sa-
crum.besides,intbiscaseitrarelycausespain. >implebypertro-
pbyofatransverseapopbysis,itsmoreor less real contactwitb
tbesacraltubercle,areoftendeemedresponsibleforimaginaryills.
|nsbort,wearedealingwitbanatomicalanomaliesofacongenital
kindwbicbbecomepainfulonlylaterandsometimesnever[ 1 01 ].
Tbeproblemofdistinguisbingbetweenananomaly wbetbermor-
pbological like tbe cervical rib orsacralization of tbe hftb lum-
bar,orfunctionallikebemopbilia,bemeralopiaorpentosuria and
tbepatbologicalstateisnotatallaclearone,butitisnevertbe-
less quiteimportantfromtbebiologicalpointofviewbecausein
tbeend it leads us to notbing less tban tbegeneralproblemof
tbevariabilityoforganismsandtbesignihcanceandscopeoftbis
variabilityTotbeextenttbatlivingbeingsdivergefromtbespecihc
type, are tbey abnormal intbat tbey endangertbespecihcform
or are tbey inventors on tbe road to new forms? One looks ata
living being baving some newcbaracteristic witb a differenteye
dependingonwbetberoneisahxist[xiste] oratransformist.Un-
derstandablywebaven'ttbesligbtestintentionofdealingwitbsucb
aproblembere, tbougbwe cannotpretendtoignore it. Wbena
drosopbilawitbwingsgives birtb,tbrougbmutation,toadrosopb-
ilawitboutwingsorwitbvestigial wings,arewebeingconfronted
witba patbological factornot?biologistslikeCaullery, wbo do
not admit tbatmutations are adequate foranunderstanding of
tbefactsofadaptationandevolution,orlikebounoure,wbodis-
puteeventbe factof evolution, insist ontbesubpatbologicalor
franklypatbologicalandevenletbalcbaracterofmostmutations.
|ftbeyarenothxistslikebounoure[ 1 6] tbeyatleastagreewitb
Caullerytbatmutationsdonotgobeyondtbeframeworkof tbe
species,since,despiteconsiderablemorpbologicaldifferences,fer-
tilecrossbreedingispossiblebetweencontrolandmutantindivid-
uals[ 24, 414]. |tstillseemsindisputabletbatmutationscanbetbe
originof newspecies.Tbisfactwasalreadywell knowntoLar-
winbutitstruckbimlesstbanindividualvariabilityCuynottbinks
1
4
1
tbatitistbeonlypresentlyknownmode ofbereditaryvariation,
tbeonlyexplanation,partialbutunquestionable,ofevolution[ 51 J.
Teissierand|bilippeL'Uritierbavedemonstratedexperimentally
tbatcertainmutations,wbicbcanseemdisadvantageousinaspe-
cies'susuallyappropriateenvironment,canbecomeadvantageous
sbould certain conditionsof existencevary. |n afreeandclosed
environmentdrosopbilawitbvestigialwingsarewipedoutbydro-
sopbilawitbnormal wings. but inanopen environmenttbeves-
tigialdrosopbiladonotlly,feedconstantly,andintbreegenerations
weseesixtypercentvestigialdrosophlainamixedpopulation[77].
Tbisneverbappensinaclosedenvironment. Letusnotsaynor-
malenvironmentbecauseintbeend,accordingtoCeoffroy>aint-
Uilaire,wbatistrueofspeciesisalsotrueofenvironments.tbey
arealltbattbeymustbeasafunctionofnaturallaws, andtbeir
stabilityisnotguaranteed. Anopenseasboreenvironmentis an
indisputablefact,buttbiswillbeamorenormalenvironmentfor
winglessinsectstbanforwingedonesbecausetbosewbo donot
llyarelesslikelytobeeliminated. Larwinbadnoticedtbisfact,
wbicbwasnottakenseriouslyandwbicbisconhrmedandexplained
bytbeexperimentsreportedabove.Anenvironmentisnormalbe-
causealivingbenglivesoutitslifebettertbere,maintainsitsown
normbettertbere.Anenvironmentcanbecallednormalwitbref-
erenceto tbe livingspeciesusingit toitsadvantage. |t is normal
onlyin terms of amorpbological andfunctionalnorm.
Teissierreportsanotberfactwbicbsbowstbat,perbapswitb-
outlookingforit,life,usingtbevariationoflivingforms,obtains
akindofinsuranceagainstexcessivespecializationwitboutrevers-
ibility, bence witboutdexibility, wbicbisessentiallya successful
adaptation. |ncertainindustrialdistrictsinCermany andLngland
tbegradualdisappearanceofgraybutterdiesandtbeappearance
ofblackonesoftbesamespeciesbasbeenobserved. |twaspos-
sibletoestablisbtbatintbesebutterlliestbeblackcolorationwas
accompaniedbyan unusual vigor. |ncaptivity tbe blacks elimi-
natetbegrays.Wbyisn'ttbesametrueinnature?becausetbeir
colorstandsoutmoreagainsttbe barkof tbetreesandattracts
tbeattentionofbirds. Wbentbenumberofbirds diminisbes in
industrialregions,butterlliescanbeblackwitbimpunity[ 1 1 1]. |n
sbort,tbisbutterdyspecies,intbefonofvarieties,offerstwocom-
binationsofopposingcbaracteristicsandtbeybalanceeacbotber.
morevigorisbalancedbyless securityandviceversa. |neacbof
tbevariations anobstaclebasbeencircumvented,touseaberg-
sonianexpression,apowerlessnessbasbeenovercome.To tbeex-
tenttbatcircumstancesallowonesucbmorpbolgicalsolutionto
opera
einpreferencetoanotber, tbenumberof representatives

ofeacbva
ietyvaries,andavarietytendsmoreandmoretoward
a species.
Vutationismwashrstpresentedasa1orm ofexplanationfor
tbe factsofevolution,wboseadoptionbygeneticistsfurtberre-
inforcedtbe bostility sbowntowardeverycoisiderationoftbe
induenceoftbeenvironment.Todayitseemstbattbeappearance
ofnewspccies mustbeplacedattbeintersectionofinnovations
brougbtaboutbymutationsandoscillationsintbeenvironment,
and tbat a Larwinism
ejuvenated bymutationism is tbe most

llexibleandcomprebensiveexplanationoftbefactofevolution
indisputabledespiteeverytbing[56, I l l ]. Tbespeciesistbegroup-
ingofindividuals,allofwbomaredifferenttosomedegree,wbose
unity expresses tbe momentary normalization of tbeir relations
witb tbe environment, includingotber species, as Larwin bad
clearly seen. Takenseparately, tbe livingbeing andbis environ-
mentarenotnormal.itistbeirrelationsbiptbatmakestbemsucb.
!oranygivenform oflife tbeenvironmentisnormaltotbeex-
tenttbatitallowsitfertilityandacorrespondingvarietyofforms
sucb tbat, sbould cbanges intbe envirnmentoccur, life will be
able tohndtbesolutiontotbeproblemofadaptation wbicb it
1
4
3
basbeenbrutallyforcedtoresolve inoneoftbeseforms.Aliv-
ingbeing isnormal inanygivenenvironmentinsofaras itistbe
morpbologicalandfunctionalsolutionfoundbylifeasaresponse
to tbedemandsof tbeenvironment. Lvenifitisrelativelyrare,
tbislivingbeingisnormalintermsofeveryotberformfromwbicb
itdiverges, because intermsoftboseotberformsitisnormative,
tbai is, it devalues tbem before eliminatingtbem.
Uence,hnally,weseebowananomaly,particularlyamutation,
i. e. , adirectlybereditaryanomaly,isnotpatholo8ical becauseitis
an anomaly, tbatis, a divergence from a specihctype, wbicbis
dehned as a group oftbemostfrequent cbaracteristics in tbeir
averagedimension.Otberwiseitwouldbavetobesaidtbatamu-
tantindividual,astbepointofdepartureforanewspecies,isbotb
patbological,becauseitisadivergence,andnormal,becauseitmain-
tains itself andreproduces. |nbiologytbenormalisnotsomucb
tbeoldastbenewform,ifithndsconditionsofexistenceinwbicb
itwillappearnormative,tbatis, displacingallwitbered,obsolete
andperbaps soontobeextinctforms.
Nofacttermednormal, because expressedassucb, canusurp
tbe prestige of tbe norm of wbicbitistbe expression, starting
fromtbemomentwben tbe conditions inwbicb itbas beenre-
ferredtotbenormarenolongergiven.Tbereisnofactwbicbis
normalorpatbologicalinitsell. Ananomalyoramutationisnot
initselfpatbological.Tbesetwoexpressotberpossiblenormsof
life.|ftbesenormsareinferiortospecihcearliernormsinterms
ofstability,fecundity,variabilityoflife,tbeywillbecalledpatbo-
logical. |ftbesenormsintbesameenvironmentsbouldturnout
to beequivalent,orinanotberenvironment,superior,tbeywill
becallednormal. Tbeirnormalitywillcome to tbemfromtbeir
normativity. Tbe patbologicalis nottbe absence of a biological
norm.itisanotbernormbutonewbicbis,comparativelyspeak-
ing, pusbedaside by life.
Uerewe baveanewproblemwbicbleadsus t otbebeartofour
concerns and tbat is tbe relationsbip of tbe normal and tbe ex-
perimental.Wbatpbysiologistsafterbernardunderstandasnor-
mal pbenomena arepbenomenawbosecontinuousexplorationis
possibletbankstolaboratoryequipment,andwbosemeasuredcbar-
acteristicsforanygivenindividualingivenconditionsturn out to
beidenticaltotbemselves,and,asidefromsomedivergencesofa
clearlydebnedamplitude,identicalfromoneindividualtoanotber
inidenticalconditions. |twouldseemtbentbattbereisonepos-
sibledebnitionoftbenormal,objectiveandabsolute,startingfrom
wbicbeverydeviationbeyondcertainlimitswouldlogicallybe as-
sessedaspatbological. |nwbatsensearelaboratorystandardization
andmensurationappropriateto serve as tbenormfortbeliving
being's functional activity considered outsidetbe laboratory?
!irstofall, itsbouldbepointedouttbattbepbysiologist,like
tbe pbysicistand cbemist, setsupexperimentswboseresults be
comparesusingtbisfundamentalmentalreservationtbattbesedata
arevalidallotbertbingsbeingequal. |notberwords,otbercon-
ditionswouldgiverisetootbernorms. The living being's functional
norms as examined in tbe laboratory are meaningful onlywitbin
tbehameworkofthe scientist 's operative norms. |ntbissensenopbysi-
ologistwould disputetbefacttbat begives only acontentto tbe
conceptof tbebiologicalnormbut tbat innocasedoes bework
outinwbatwaysucbaconceptisnormative. Uavingadmittedtbat
some conditions are normal, tbe pbysiologist objectivelystudies
tberelationswbicbactuallydehnetbecorrespondingpbenomena,
butbedoesnotreallyobjectivelydebnewbicbconditionsarenor-
mal . Unless one admits tbat anexperiment'sconditionsbaveno
induenceontbequalityoftberesult wbicbisinconsistentwitb
tbecaretakentodeterminetbem onecannotdenytbedifhculty
inassimilatingexperimental conditions witbtbenormal ones of
animal andbuman life, intbestatisticalaswell as intbe norma-
1
45
tivesense. |ftbeabnormal orpatbologicalisdehnedasastatisti-
caldivergenceorassometbingunusual,astbepbysiologistusually
dehnesit, itmustbesaid,fromapurelyobjectivepointofview,
tbat tbe laboratory's conditions forexamination place tbe living
being in a patbological situation from wbicb, paradoxically, one
claimstodrawconclusionsbavingtbeweigbtofanorm.Weknow
tbattbisobjectionisveryoftendirectedatpbysiology,eveninmed-
ical circles. |rus,intbesameworkfrom wbicbwe bavealready
quoteda passage attacking broussais's tbeories, states.
Artihcial diseasesandtberemovalof organs practicedinex-
periments on living animals, lead totbe same result[as spon
taneous diseases]; bowever, itis important topointouttbatit
wouldbewrongtoproceedfromservicesrenderedbyexperi-
mentalpbysiologytofavoringtbeinlluencepbysiologycanexert
onpracticalmedicine... . Wbenweirritate, puncture,cuttbe
brain andcerebelluminorderto learn tbefunctionsof tbese
organs, orwbenwe cutoutamoreorlessconsiderablepor-
tion,tbe animal subjectedtosimilarexperimentsiscertainly
asfarremovedaspossiblefromtbepbysiologicalstate,itisse-
riouslysickandwbatiscalledexperimental phYSiology isobvi-
ouslynotbingotbertbanarealarticial patholog wbicbissimilar
to orcreates diseases. Of course, pbysiology bas i ts leading
ligbts,andtbenamesofVagendie,Orhla,!lourenswillalways
baveaplaceofbonorinitsannals,buttbeseverybguresolIer
anautbenticandinsomewaymaterialproof ofeverytbingtbis
scienceowes to tbe science of disease [95, L sqq. ].
|tistotbiskindofobjectiontbatClaudebernardrepliedin
tbeLerons sur la chaleur animale:
Certainlyanexperimentintroduces disturbances into tbeor-
ganism,butwemustandcanbeartbisinmind. We mustre-
store tbe part of tbe anomalies wbicb is due to tbem to tbe
conditionsinwbicbweplacetbeanimal,andsuppresstbepain
inanimalsaswellasinmaninordertoremovecausesforerror
brougbtaboutbysuffering. buttbeveryanestbeticsweusebave
effects on tbe organism wbicb can give rise to pbysiological
modihcations and new causes for error in ourexperiments'
results [8, 57].
Anotewortbypassage, wbicbsbows bow closebernardistoas-
sumingtbat itispossibletodiscoveradeterminism oftbepbe-
nomenon, independent of tbedeterminism of tbeoperation of
knowledge, andbowbe is bonestlyobligedtoacknowledge tbe
alteration, in clearly unassignable proportions, to wbicb knovl-
edge subjects tbe known pbenomenon because of tbe tecbnical
preparationitinvolves.Wbenweglorifytbecontemporarytbeo-
rists of wave mecbanics for tbeirdiscoverytbatobservationin-
terfereswitbtbeobservedpbenomenon,itbappenstbat,asinotber
cases, tbe idea isa bit older tban tbey are.
|ntbe courseof bis researcb, tbepbysiologistmustcome to
gripswitbtbreekindsofdifhculties. !irstbemustbecertaintbat
tbe subject wbicb is called normal intbeexperimentalsituation
isidenticalwitbtbesubjectoftbesamespeciesinanormal ,i. e. ,
nonartihcial situation. Tbenbemustbecertainoftbesimilarity
betweentbepatbologicalstatebrougbtaboutbyexperimentand
tbespontaneouspatbologicalstate.Oftentbesubjectintbespon-
taneouspatbologicalstatebelongstoaspeciesotbertbantbesub-
jectoftbeexperimentalpatbologicalstate. !orexample,witbout
greatprecautionswecannotdrawanyconclusionsabouttbedia-
beticbumanfromVeringandVinkowski'sdog, orYoung's. !i-
nally,tbepbysiologistmustcomparetberesultoftbetwopreceding
comparisons. Noonewillquestiontbebreadtboftbemargin of
' 4
7
uncertaintyintroducedbysucbcomparisons. |tisasvaintodeny
tbe existence of tbis margin as itiscbildisbtoquestiona priori
tbeutilityof sucb comparisons. |n any case one understandstbe
difhcultyinrealizingtbecanonicalrequirementof'allotbertbings
being equal. A convulsivecrisis can bebrougbt onbystimulat-
ingtbecerebralcortexattbefrontalascendant, butitstillisnot
epilepsyevenif tbeelectroencepbalogram, aftera successionof
tbesecrises,recordssuperimposablecurves. !ourpancreasescan
begraftedsimultaneouslyontoananimalwitbouttbeanimalex-
periencingtbesligbtestbypoglycemicdisordercomparabletotbat
brougbtaboutbyasmalladenomaintbeislesofLangerbans[ 5 3 .
bis]. >leep can be inducedby sleeping pills but accordingto A.
>cbwartz.
|twould bewrongtobelievetbat sleep brougbton bypbar-
macologicalmeansandnormalsleepnecessarilybaveanexactly
similar phenomenolog intbeseconditions. |nrealitytbetwocases
arealwaysdifferentastbefollowingexamplesprove.if,forex-
ample, tbeorganismisundertbe inlluence ofacortical seda-
tive,paraldehyde, tbe volume of urineincreases, wbile intbe
courseofnormalsleepdiuresisisusuallyreduced.Tbecenter
of diuresis, initiallyliberatedby tbe depressiveactionof tbe
sedativeontbecerebralcortex,istbussbieldedfromtbesub-
sequentinbibitoryactionof tbesleepcenter.
|tmustbeadmittedtbatartihciallyinducingsleepbyinterfering
witbtbenervecentersdoesnotenligbtenusastotbemecbanism
bywbicb tbebypnotic centerisnaturallyputinto operationby
tbe normal factors of sleep [ 1 05, 23-28].
|fwemay deb netbenormal stateofa livingbeingin terms
ofanormalrelationsbipofadjustmenttoenvironments,wemust
notforgettbattbelaboratoryitselfconstitutesa new environment
inwbicblifecertainlyestablisbesnormswboseextrapolationdoes
notworkwitboutriskwbenremovedfromtbeconditionstowbicb
tbese normsrelate. !ortbeanimal orformantbelaboratoryen-
vironmentisonepossibleenvironmentamongotbers. Certainly,
tbe scientistisrigbt inseeing in bis apparatus only tbe tbeories
wbicbitmaterializes, toseeintbeproducts usedonlytbereac-
tions tbeyallow, be isrigbt inpostulatingtbe universal validity
oftbesetbeoriesandtbesereactions,butfortbelivingbeingap-
paratusandproductsaretbeobjectsamongwbicbbemovesasin
anunusualworld. |tis notpossibletbattbeways of life in tbe
laboratoryfailtoretainanyspecib cityintbeirrelationsbiptotbe
placeandmomentof tbe experiment.
1
49
Cn- e+r s | | |
Norm and Avera
g
e
|t seems tbat in tbe conceptofaverage tbepbysiologist hnds an
objectiveandscientihcallyvalidequivalentoftbeconceptofnor-
malornorm. Certainlytbecontemporarypbysiologistnolonger
sbaresClaudebernard'saversionforeveryresultofanalysisorbi-
ological experiment expressedas an average, anaversion wbicb
perbapsoriginatedinoneof bicbat's texts.
Urine,saliva,bile,etc. ,takenatrandomfromtbisortbatsub-
j ectareanalyzedandfrom tbeirexaminationanimalcbemis-
try is born,wbateveritmaybe. buttbisisnotpbysiological
cbemistry,if|maysayso,itistbecadaverousanatomyoflluids.
Tbeirpbysiologyconsistsintbeknowledgeofinnumerablevari-
ationsundergonebytbelluidsastbeyfo|lowtbestateoftbeir
respectiveorgans[ 1 2, art. 7, I ].
benardisequallyclear.Accordingtobim, tbeuseofaverageserases
tbeessentiallyoscillatoryandrbytbmiccbaracteroftbemnctional
biologicalpbenomenon.!orexample,ifwelookfortbetruenum-
berof beartbeats usingtbeaverageof measurements takensev-
eraltimeson tbe samedayfrom onegivenindividual, 'wewill
clearlybavea falsenumber. Uence tbis rule.
I S I
|npbysiologyaveragedescriptionsofexperimentsmustnever
begivenbecausetberealrelationsofpbenomenadisappearin
tbisaverage,wbendealingwitbcomplexandvariableexperi-
ments,wemuststudytbeirdifferent circumstances andtben
offer tbemostperfectexperimentas type,wbicbwill always
representa true fact6, 26].
Researcbonaveragebiolo
icalvaluesbasnomeaningasfarastbe
sameindividualisconcerned.forexample,tbeanalysisofaverage
urineoveraz+-bourperiodis'tbeanalysisofaurinewbicbdoes
notexistsinceurinefromtbefastingstatediffers fromtbatof
digestion. Tbis researcbisequallymeaninglessasfarasindividu-
alsareconcerned.
Tbe culminationof tbis kindof experiment]was conceived
byapbysiologistwbo tookurinefromtbeurinalattbetrain
stationtbrougbwbicbpassedpeopleofallnations,andbelieved
be couldtbusproducetbe analysis ofaverage Luropeanurine
6, 236].
Witboutwisbingtoreproacbbernardforconfusingresearcbwitb
itscaricatureandforloadingametbodwitbfaultswbenrespon-
sibilityfor itlieswitbtbosewbo useit,we sballlimitourselves
tomaintainingtbat,accordingtobim,tbenormalisdehnedasan
idealtype indeterminedexperimentalconditionsratbertban as
anaritbmetical average orstatisticalfrequency.
Ananalogousandagainmorerecentattitudeistbatof\endrys
in bis Vie et probabilite wbere bernard's ideas on tbe constancy
andregulationsoftbeintemalenvironmentaresystematicallyre-
examinedanddeveloped.Lehningpbysiologicalregulationsas'tbe
complexoffunctionswbicbwitbstandcbance l l , i -],or,if
onewantsfunctionswbicbcausetbelivingbeing'sactivitytolose
NORM AND AVERAGE
itscontingentanduncertaincbaracter(wbicbwouldbelongtoit
weretbeinternalenvironmentdeprivedofitsautonomyvis--vis
tbeexternalenvironment),\endrysinterpretstbevariationsun-
dergonebypbysiologicalconstants glycemia,forexample asdi-
vergencesfromanaverage,butanindividualaverage.Tbeterms
divergence and average bere bave a probabilistic meaning. Tbe
greatertbe divergences tbe more improbable tbey are.
| donotdevelopstatisticsonacertainnumberofindividuals.
|considerj ustoneindividual.Tbetermsaveragevalueanddi-
vergence undertbese conditions are appliedto tbe dilIerent
valueswbicbtbesamecomponentoftbesameindividual'sblood
can assume insuccessive time periods l l , 33].
butwedonottbinktbat \endrys tbereby eliminatestbedifh-
cultybernardresolvedbyproposingtbemostperfectexperiment
as a type, tbat is, as a norm for comparison. |n doingtbis, ber-
nardopenlyadmittedtbattbepbysiologistbringstobeartbenorm
ofbisowncboosingintbepbysiologyexperimentandtbatbedoes
notwitbdrawit. Wedonot tbinktbat\endryscanproceeddif-
ferently. Uesaystbattbeaverage valueofglycemiais lwbereas
weknowtbat]normallytberateofglycemiais l,butaftereat-
ingormuscularwork,glycemiaundergoespositiveornegativedi-
vergencesfrom tbis average value. butassuming one eectively
limitsoneselftoobservingoneindividual,bowdoesoneconclude
a priori tbattbeindividualcbosenastbesubjectfortbeexamina-
tionofvariationsofaconstantrepresentstbebumantype?Litber
oneisadoctor andtbisisapparentlytbecasewitb\endrys and
consequently qualib ed to diagnose diabetes , orone baslearned
notbingaboutpbysiologyintbecourseofmedicalstudies,andin
ordertolearntbenormalrateofoneregulationonewilllookfor
tbe averageof acertainnumberof resultsobtainedfromindivid-
ualsplacedinconditionsassimilaraspossible.butintbeendtbe
problemisto knowwitbin wbat range ofoscillationsarounda
purelytbeoretical average valueindividualswill be considered
normal.
A. Vayer z] andU. Laugier7l ] bavedealtwitbtbis prob-
lemwitbgreatclarityandbonesty. Vayerenumeratesalltbeele-
mentsofcontemporarypbysiologicalbiometry.temperature,basal
metabolism, blood gases, free beat, cbaracteristicsof tbe blood,
rateofcirculation,compositionoftbeblood,reserves,tissues,etc.
Nowbiologicalvaluesallowamarginofvariation.|nordertorep-
resentaspecieswebavecbosennormswbicbareinfactconstants
determined byaverages.Tbenormal livingbeingistbeonewbo
conformstotbesenorms.butmustweconsidereverydivergence
abnormal?
|nrealitytbemodelistbeproductofstatistics, mostoftenit
istberesultoftbecalculationsofaverages.buttberealindi-
vidualswbomwe meet diverge from tbesemore orless and
tbisis preciselyinwbat tbeirindividualityconsists. |twould
beveryimportanttoknowwbattbedivergencesrelatetoand
wbicbdivergencesarecompatiblewitbextendedsurvival.Tbis
sbouldbeknown for tbe individuals of eacbspecies. >ucba
study is farfrom being done z, 4. 4i 4].
Laugiersbowstbedifb cultyofsucbastudydealingwitbman. Ue
doesitbrstbyexpoundingQuetelet'stbeoryoftbeaverase man,
towbicbwe sball return.TbeestablisbmentofoneofQuetelet's
curvesdoesnotsolvetbeproblemoftbenormalforagivencbar-
acteristic,forexample, beigbt. Cuiding bypotbesesandpractical
conventions are needed, allowingoneto decide wbatvalue for
beigbts,eitbertowardtbetallortbesbort,constitutestbetransi-
tionfromnormaltoabnormal.Tbesameproblempresentsitself
1
54
NORM AND AVERAGE
i wesubstituteasetof aritbmeticalaverageswitbastatisticalplan
from wbicbany individual divergesmore orless,becausestatis-
ticsoer nomeansfordecidingwbetbera divergenceisnormal
orabnormal. Usingaconventiontbatreasonitselfseems tosug-
gest, couldone perbaps considerasnormaltbeindividualwbose
biometricalprohleallowsonetopredicttbat,barringanaccident,
bewill bavealife spanappropriate to bisspecies?buttbe same
questions reappear.
|n individuals wboapparentlydieof senescence,wewillhnd
averywidespreadoflifespans. >ballwetakeastbespecies's
life span tbeaverageof tbesespansortbemax|mumspans
reacbedby somerareindividuals, orsomeotbervalue?[7 1 ,
4. 56-4]
Voreover,tbisnormalitywouldnotexcludeotberabnormalities.
acertaincongenitaldeformitycanbecompatiblewitbaverylong
life.>trictlyspeaking,iftbeaveragestateoftbecbaracteristicstud-
iedintbeobservedgroupcanfurnisbasubstituteforobjectivity
intbedeterminationofapartialnormality,tbenatureoftbesec-
tionabouttbeaverageremainsarbitrary,inanycaseallobjectiv-
ityvanisbes intbedeterminationof a universal normality.
Civentbe inadequacy of biometricalnumerical data and tbe
uncertaintyastowberewearewitbregardtotbevalidityof
tbeprinciplesto beusedinestablisbingtbedividinglinebe-
tweennormalandabnormal,tbescientihcdehnitionof nor-
mality, at tbe moment, seems beyond reacb [ibid. ].
| si tstillmoremodestor,ontbeotberband,moreambitious
toasserttbelogical independence of tbeconceptsofnormand
average andconsequentlytbedehnitiveimpossibilityofproduc-
ingtbefullequivalentof tbeanatomicalorpbysiologicalnormal
in tbeform of an objectivelycalculatedaverage?
>tartingwitbQuetelet'sideasandUalbwacbs'sveryrigorousex-
aminationsoftbem,we intendtosummarizetbeproblemoftbe
meaning and scope of biometric researcb in pbysiology. On tbe
wboletbepbysiologistwboreviewsitsbasicconceptsiswellaware
tbatforbim norm and average aretwoinseparableconcepts.but
averageseemstobimto be directlycapableof objective dehni-
tionandsobetriestoj oinnontoit.Webavejustseentbattbis
attemptatreductionrunsintodifhcultieswbicbarencw,andun-
doubtedlyalwayswillbe,insurmountable.Woulditnotbeappro-
priate to turn tbe problem aroundandto askwbetbertbelink
betweentbetwoconceptscouldn'tbeexplainedintermsoftbe
subordinationofaveragetonorm?Weknowtbatbiometryasap-
pliedto anatomywasb rstestablisbedbyCalton'sworks, wbicb
generalizedQuetelet'santbropometricprocedures. |nsystemati-
callystudyingtbevariationsinbumanbeigbt,Queteletbadestab-
lisbedandrepresentedgrapbicallytbeexistenceofapolygonof
frequencysbowinganapexcorrespondingtotbemaximumordi-
nate,andasymmetryintermsoftbisordinateforacbaracteris-
ticmeasuredinindividualsofabomogeneouspopulation.We know
tbat tbelimitofapolygonisacurveanditwasQueteletbimself
wbosbowedtbattbepolygonoffrequencytendstowardaso-called
'bell-sbapedcurvewbicbistbebinomialorCaussianerrorcurve.
bymeansoftbisrelationsbipQueteletexpresslywantedtodem-
onstratetbatberecognizedagivencbaracteristic'sindividualvari-
ation(lluctuation)onlyintermsoftbatofanaccidentverifying
tbelawsofcbance, tbatis,tbe lawswbicbexpresstbeinlluence
ofanunassignablemultiplicityofnonsystematicallyorientedcauses
wboseeffectsconsequentlytendtocanceloutoneanotbertbrougb
NORM AND AVERAGE
progressivecompensations.Now,to Quetelet tbispossibleinter-
pretationofbiologicallluctuations intermsoftbecalculationof
probabilitiesseemedoftbegreatestmetapbysicalimportance.Ac-
cordingto bimitmeanttbereexists'atypeormodulefor tbe
bumanrace 'wbosedifferentproportions couldbeeasilydeter-
mined [96, / 5]. |f tbiswerenottbecase,ifmendifferedfrom
oneanotber witbrespectto beigbt,1orexample notbecause
oftbeeffectofaccidentalcausesbutbecauseoftbeabsenceofa
typewitbwbicbtbeycouldbecompared,nodebniterelationsbip
couldbeestablisbedamongalltbeindividualmeasurements. On
tbeotberband, iftbereisatype interms ofwbicbdivergences
arepurelyaccidental, a measured cbaracteristic'snumerical val-
ues, takenfrom many, many individuals, mustbedistributedac-
cordingto amatbematical lawand tbis isindeed wbatbappens.
|notberrespects, tbegreatertbenumberofmeasurementscar-
ried out, tbemore tbeaccidentaldisturbingcauseswill compen-
sateandcanceloutoneanotberandtbemoreclearlytbegeneral
type willappear. butabove all , from anylarge numberof men
wbosebeigbtvariesbetweendeterminedlimits,those who come clos
est to the average height are the most numerous, tbose wbo diverge
homittbemostaretbeleastnumerous.Queteletcalledtbisbuman
typefom which the greater the divergence, the rarer it is tbeav
erage man. WbenQueteletiscitedastbefatberofbiometry, itis
generallyleftunsaidtbatforbimtbeaveragemanisbynomeans
an 'impossibleman[96, 22]. |nagivenregiontbeproofof tbe
average man's existence isfoundintbewaytbebguresobtained
foreacbdimensionmeasured(beigbt,bead,arms,etc.)grouptbem-
selves aroundtbeaveragebyobeyingtbelawofaccidentalcauses.
Tbeaveragebeigbtinagivengroupissucbtbattbelargestoftbe
subgroupsformedofmenof tbe samebeigbtistbesetofmen
wbosebeigbtcomes closest totbeaverage.Tbismakestbe typi-
cal average completely dilIerent from tbe aritbmetical average.
1
'7
Wbenwemeasuretbebeigbtofseveralbouseswemaygetanav-
eragebeigbtbutsucbtbatnobousecanbefoundwboseownbeigbt
approacbes tbe average. |n sbort, tbe existenceof anaverage is,
accordingtoQuetelet,tbeindisputablesignoftbeexistenceofa
regularity, interpreted inanexpresslyontological sense.
!ormetbeprincipalideaistocausetbetrutbtoprevailand
tosbowbowmucbman,witboutbisknowledge,issubjectto
divinelawsandwitbwbatregularityberealizestbem.Vore-
over,tbisregularityisnotpeculiartoman.itisoneoftbegreat
laws of nature belonging to animals as well as plants, and it
will be surprising perbaps tbat itwas not recognized sooner
[96, 2 1 ].
Tbeinterestof Quetelet'sconceptionliesintbe facttbat inbis
notionoftrueaveragebeidentihestbeideasofstatistical frequency
andnorm, foranaverage wbicb determines tbat tbegreatest di-
vergencesaretbemostrareisreallyanorm.Tbisisnottbeplace
to discuss tbe metapbysical foundationof Quetelet's tbesis, but
simplyto arguetbatbe distinguisbestwokindsof averages. tbe
aritbmeticalaverageormedian andtbetrueaverage,andtbatfar
frompresentingtbeaverageastbeempiricalfoundationoftbenorm
witbregardtobumanpbysicalcbaracteristics,beexplicitlypres-
ents anontologicalregularitywbicbexpresses itselfintbeaver-
age. |fitsbouldseemquestionabletoresortto Cod's willinorder
tounderstandtbemoduleforbuman beigbt, tbis does notmean
tbatnonormsbowstbrougbintbataverage. Andtbis seems to
ustobewbatcanbeconcludedfromtbe critical examination to
wbicb Ualbwacbs subjectedQuetelet's ideas [ 5 3].
AccordingtoUalbwacbs, Queteletismistakeninconsidering
tbedistributionofbumanbeigbtsaroundanaverageasapbenom-
enontowbicbtbelawsofcbancecanbeapplied.Tbehrstcondi-
NORM AND AVERAGE
tionoftbisapplicationistbatpbenomena,takenascombinations
ofelementsofanunassignablenumber,arerealizationswbicbare
completelyindependentof oneanotber, sotbatno oneoftbem
exerts anyinlluence on tbe one tbat follows. Now,constant or-
ganiceffectscannotbe assimilatedwitb pbenomenagovernedby
tbelawsofcbance.Todosoistoadmittbatpbysicalfactsresult-
ingfrom tbe environment andpbysiologicalfacts relatedto tbe
processofgrowtbarearrangedin sucb awaytbateacbrealiza-
tion is independent of tbeotbers atanearlier, andattbe same,
time.Tbisisuntenablefromtbebumanpointofview,wbereso-
cialnormsinterferewitbbiologicallawssotbattbebumanindi-
vidualistbeproductofaunionsubjecttoallkindsofcustomary
andmatrimonial legislative prescriptions. |nsbort, beredityand
tradition,babitandcustom,areasmucbformsofdependenceand
interindividualconnectionastbeyareobstaclestoanadequateuti-
lizationoftbecalculationofprobabilities. Ueigbt,tbecbaracter-
istic studiedbyQuetelet,wouldbeapurelybiologicalfactonlyif
it werestudiedinasetofindividualsconstitutingapureline,ei-
tberanimalorplant.|ntbiscasetbelluctuationsonbotbsidesof
tbespecibcmodulewouldderivesolelyfromtbeactionoftbeen-
vironment. butintbebumanspeciesbeigbtisapbenomenon in-
separably biologicalandsocial.Lvenifbeigbtisafunctionoftbe
environment, tbe product ofbuman activity must beseen,ina
sense,intbegeograpbicalenvironment.Vanisa
eograpbicalagent
andgeograpbyistborougblypenetratedbybistoryintbeformof
collectivetecbnologies. !orexample, statisticalobservationbas
madeitpossibletoestablisbtbe inlluence oftbedrainingof tbe
>olognemarsbesontbebeigbtoftbeinbabitants[ 89]. >orreac-
knowledgestbattbeaveragebeigbtofsomebumangroupsisprob-
ablyraisedundertbeinlluenceof improved diet[ 1 09, 286]. but
webelievetbatifQueteletmadeamistakeinattributingavalue
ofadivinenormtotbeaverageofabumananatomicalcbaracter-
1
59
istic, tbis liesperbaps only inspecifyingtbe norm, not in inter-
pretingtbeaverageasasignofanorm.|fitistruetbattbebuman
bodyisinonesenseaproductofsocialactivity,itisnotabsurdto
assume tbattbe constancyof certain traits, revealedbyanaver-
age, depends ontbeconsciousorunconsciousb delityto certain
normsoflife. Consequently,intbebumanspecies,statisticalfre-
quencyexpressesnotonlyvitalbutalsosocialnormativityAbuman
trait would notbenormal becausefrequentbutfrequentbecause
normal,tbatis, normativeinonegivenkindoflife,takingtbese
wordskind o |; intbesensegiventbembytbegeograpbersof
tbescboolof\idaldelablacbe[ 1 845-1 9 1 8; founderof!rencb
'bumangeograpby].
Tbiswillappearevenmoreobviousif,insteadofconsidering
ananatomicalcbaracteristic,weconcentrateonapbysiologicalone
likelongevity. !lourens,followingbuffon,lookedforawaytode-
terminescientib callyman'snaturalornormallifespan,usingand
correctingbuffon'sworks. !lourenslinkedtbelifespantotbespe-
cib cdurationofgrowtb,wbosetermbedehned+ntermsoftbe
unionofbonesattbeirepipbyses. 'Vangrowsfortwentyyears
andlivesforb vetimestwenty, tbatis, 1 00 years. Tbattbisnor-
malbumanlifespanisneitbertbefrequentnortbeaveragedura-
tion is clearly specib ed by !lourens.
Lverydaywe seemenwbo live 90 and 1 00 years. | am well
awaretbattbenumberoftbosewboreacbtbatpointissmall
wbencomparedtotbenumberoftbosewbodonotreacbit,
butinfactsucbagesarereacbed.Andbecausetbeyaresome-
timesreacbed,itisverypossibletoconcludetbattbeywould
bereacbedmoreoften,tbattbeywouldbereacbedoftenifac-
cidentalandextrinsiccircumstances, ifdisturbingcausesdid
notgetintbe way. Vostmendiefromdisease,veryfew die,
strictlyspeaking,of oldage[39, 0 i ].
1 60
NORM AND AVERAGE
Vetcbnikoff alsotbinks tbatmancannormallybecomeacente-
narianandtbateveryoldmanwbodiesbefore 1 00 yearsofageis
intbeorya sickman.
Tbe variations inman's averagelifespantbrougbtbeyears( 19
in l 6and52 in 1 920 in!ranceformales)arequiteinstructive.
|nordertoassignanormallifetoman,buffonand!lourenscon-
sideredbimfrom tbe samebiologicalperspectivetbattbeyused
fortberabbitorcamel.butwbenwespeakofanaveragelife,in
ordertosbowitgrowinggradually, welinkittotbeactiontbat
man,takncollectively,exercisesonbimself.|tisintbissensetbat
Ualbwacbsdealswitbdeatbasasocialpbenomenon,believingtbat
tbe ageat wbicbdeatboccurs resultslargelyfromworkingand
bygienicconditions,attentionpaidtofatigueanddiseases,insbort,
fromsocialasmucbaspbysiological conditions. Lverytbingbap-
pensasifasocietybad'tbemortalitytbatsuitsit, tbenumber
oftbedeadandtbeirdistributionintodifferentagegroupsexpress-
ingtbeimportancewbicbtbesocietydoesordoesnotgivetotbe
protractionof life [ 53, 94-97]. |n sbort, tbe tecbniquesof col-
lectivebygienewbicbtendtoprolongbumanlife,ortbebabitsof
negligencewbicbresultinsborteningit,dependingontbe value
attacbedtolifeinagivensociety, areintbeendavaluej udgment
expressedintbeabstractnumberwbicbistbeaveragebumanlife
span. Tbeaveragelifespanisnottbebiologicallynormal,butina
sensetbesociallynormative,lifespan. Oncemoretbenormisnot
deducedfrom, butratberexpressedintbe average. Tbis would
beclearerstillif,insteadofconsideringtheaveragelifespanina
nationalsocietytakenasawbole, webroketbissocietydowninto
classes,occupations, etc. Wewould see, of course, tbattbe life
spandependsonwbatUalbwacbscallselsewberetbelevelsoflife.
Undoubtedlyitwillbeobjectedtbatsucbaconceptionisvalid
forsuperhcial buman cbaracteristicsfor wbicb tbere does exist,
for tbemostpart,amarginoftolerancewberesocialdiversities
areinevidence,buttbatitcertainlyisnotsuitableforeitberfun-
damentalbumancbaracteristics,wbicbareessentiallyrigidsucb
asglycemia, calcemia, or blood pU, or,generally speaking, for
strictlyspecihc cbaracteristics in animals to wbicb no collective
tecbniqueoffersanyrelativeplasticity. Ofcourse,wedon'tintend
tomaintaintbatanatomicpbysiologicalaveragesexpress social
normsandvaluesinanimals,butwedoaskwbetbertbeywouldn't
expressvitalnormsandvalues.|ntbeprevioussectionwesawtbe
examplementionedbyC.Teissieroftbatbutterdyspecieswbicb
oscillates betweentwo varieties, tendingtoblendinwitboneor
tbeotber,dependingonwbicboftbetwocombinationstbatare
compensatedwitbcontrastingcbaracteristicstbeenvironmenttol-
erates.Wemaywellaskwbetbertberewouldn'tbeakindofgen-
eral rulefortbe inventionof living forms. Consequently, a very
differentmeaning could begiven to tbe existenceofanaverage
of tbemostfrequentcbaracteristicstbantbat attributed toitby
Quetelet. |t would not express a specihc stable equilibrium but
ratbertbeunstableequilibriumofnearlyequalnormsandforms
oflifetemporarilybrougbttogetber.|nsteadofconsideringaspe-
cihctypeasbeingreallystablebecauseitpresentscbaracteristics
devoidofanyincompatibility, itcouldbeconsideredasbeingap-
parentlystablebecauseitbastemporarilysucceededinreconcil-
ing opposing demands bymeans of a set of compensations . A
normalspecihcformwouldbetbeproductofanormalizationbe-
tweenfunctionsandorganswbosesyntbeticbarmonyisobtained
indehnedconditionsandisnotgiven.TbisisalmostwbatUalb-
wacbs suggested in 1 9 1 2 in bis criticism of Quetelet.
Wbysbouldweconceiveoftbespeciesasatypefromwbicb
individualsdivergeonlybycbance?Wbywouldn'titsunitybe
tberesultofadualityofconformation,aconllictoftwoora
very small numberof general organictendencieswbicb, all
NORM AND AVERAGE
tbingsconsidered,wouldbalanceeacbotberout?Wbatcould
bemorenaturaltbantbeexpressionoftbisdivergenceofits
members'activitiesintermsofaregularseriesofdivergences
fromtbeaverageintwodilIerentdirections. . . . |ftbesediver-
gencesweremorenumerous in one direction, tbis would in-
dicatetbattbespeciestendstoevolveintbatdirectionunder
tbe ind uenceof one ormore constant causes 1, 6 i ].
Asfarasmanand bis permanentpbysiologicalcbaracteristics
areconcerned,onlyacomparativebumanpbysiologyandpatbo-
logy intbesensetbattbereexistsacomparativeliterature of
tbevariousetbnic,etbicalorreligious,andtecbnicalgroupsand
subgroups,wbicbwouldtakeintoaccountlife'sintricacyandits
kinds and social levels, couldfurnisba precise answertoour
bypotbeses.|tseemstbattbiscomparativebumanpbysiology, done
fromasystematicpointof view, still remains tobe written bya
pbysiologist. Of course, tbere are compactcompilationsof bio-
metricaldataofanatomyandpbysiologyconcerninganimalspe-
ciesaswellastbebumanspeciesseparatedintoetbnicgroups,for
example tbe Tabulae biolosicae ]unk,Tbe Uague], but tbese are
listswitboutanyattemptataninterpretationoftberesultsoftbe
comparisons.bycomparativebumanpbysiologywemeantbatkind
ofresearcbbestrepresentedbytbeworksofLijkmann, benedict
andOzoriodeAlmeidaonbasalmetabolismanditsrelationswitb
climateandracebibliograpbyin61 , 2--]. butitbappenstbattbis
gapbasjustbeenb lledinpartbytberecentworksoftbe!rencb
geograpber, >orre, wboseLes fondements bioloSiques de la seosra
phie humaine Tbebiological !oundations of UumanCeograpby]
was drawn to ourattentionwben tbedraftingof tbe essay was
completed. Wesball saysometbing abouttbis later, following a
developmentwbicbwewanttoleaveinitsprimitivestate,noto
mucboutofconcernfororiginalitytbanasevidenceofaconver-
gence.Vetbodologically, tbeconvergencebyfarprevailsovertbe
originality.
!irstofall,itwillbeagreedtbatindeterminingpbysiologicalcon-
stantsbyconstructingaveragesobtainedexperimentallyonlywitbin
tbe laboratory framework, onewould runtberisk ofpresenting
normalmanasamediocreman,farbelowtbepbysiologicalpos-
sibilitiesofwbicbmen, actingdirectlyandconcretelyontbem-
selvesortbeenvironment,orobviouslycapable,eventotbeleast
scientihcallyinformedobservers.Onemayanswerbypointingout
tbattbefrontiersoftbelaboratorybaveverymucbexpandedsince
Claudebernard,tbatpbysiologyextendsitsjurisdictionovervo-
cationalguidanceandselectioncentersandpbysicaleducationin-
stitutes,insbort,tbattbepbysiologistlookstotbeconcreteman,
not tbe laboratory subject in averyartib cial situation, andtbat
bebimselfdeterminestbetoleratedmarginsofvariationswitbbio-
metricalvalues. WbenA. Vayerwrites.
Tbeveryaimoftbeestablisbmentofsportsrecordsistomea-
suretbemaximumactivityofman'smusculature[82, 4. 54..14],
we tbink ofTbibaudet's witty remark.
|tistberecordhgures,notpbysiology,tbatanswerstbeques-
tion.bowmanymeters canamanj ump?[Le bergsonisme (|aris,
Lditions delanouvellerevuefranaise, 1 923) 1, 203].
|nsbort,pbysiologywouldbeonlyonesureandprecisemetbod
forrecordingandstandardizingtbefunctionalfreedomsacquired
orratberprogressivelymasteredbyman. |fwecanspeakofnor-
malmanasdeterminedbytbepbysiologist,itisbecausenorma-
NORM AND AVERAGE
tivemenexistforwbomitisnormaltobreaknormsandestablisb
new ones.
Asanexpressionofbumanbiologicalnormativity,notonlydo
individual variations ontbeso-calledcivilizedwbiteman's com-
mon pbysiological 'tbemesseeminteresting, butevenmore so
aretbevariationsoftbetbemestbemselvesfromgrouptogroup,
dependingontbetypesandlevelsoflife,asrelatedtolife'setbi-
cal orreligiousattitudes,insbort,tbecollectivenormsoflife.|n
connectionwitbtbis,CbarlesLaubryandTbrsebrosse,tbanks
totbemostmodernrecordingtecbniques,bavestudiedtbepbys-
iologicaleffectsoftbereligiousdisciplinewbicballowsUinduyogis
almostcompletemasteryovertbefunctionsof vegetativeexistence.
Tbismastery is sucb tbatitsucceedsinregulatingtbeperistaltic
and antiperistaltic movements andinusingtbeanalandvesical
spbinctersineverypossibleway,tbusabolisbingtbepbysiological
distinctionbetweensmootbandstriatedmusclesystems.Tbismas-
tery abolisbes eventbe relative autonomy of tbe vegetativelife.
Tbe simultaneous recordingof pulse, respiration, electrocardio-
gram,andtbemeasurementofbasalmetabolismbaveallowedone
to establisbtbatmental concentration, asittendstowardtbefu-
sionoftbeindividualwitbtbeuniversalobject,producestbefol-
lowingeffects.acceleratedbeartrbytbm,modihcationoftbepulse's
rbytbmandpressure,andmodibcationoftbeelectrocardiogram.
low generalized voltage, disappearance of waves, inhnitesimal
hbrillationontbeisoelectricline,reducedbasalmetabolism70,
i 604].Tbekeytotbeyogi'sactiononpbysiologicalfunctions,wbicb
seemleastsubjecttotbewill,liesinbreatbing,itisbreatbingwbicb
isrequiredtoactontbeotberfunctions,byreducingittbebody
isplaced'intbestateof slowedexistencecomparable totbatof
bibernating animalsi|ic ]. Toobtaina cbange inpulse rbytbm
from 0 to l 0, an apnea absenceofrespiration]of l minutes,
an almost total suppressionof cardiac contraction, certainly
amountstobreakingpbysiologicalnorms. Unlessone cboosesto
considersucb results patbological. but tbis isclearly impossible.
|fyogisareignorantoftbestructureoftbeirorgans,tbeyare
indisputablemastersoftbeirfunctions.Tbeyenjoyamagnihcent
stateofbealtbandyettbeybaveindictedontbemselvesyears
ofexerciseswbicbtbeycouldn'tbavestoodiftbeybadn'tre-
spected tbe laws of pbysiological activity [ibid. ].
Laubry andbrosse conclude from sucb facts tbatwearein tbe
presenceofabumanpbysiologywbicbisverydifferentfromsim-
p|eanimal pbysiology. 'Tbewillseemsto actasa pbarmacody-
namic test andforour superior faculties we glimpse an inb nite
powerofregulationandorder[ibid. ]. Wbencetbeseremarksof
brosseon tbe problem of tbe patbological.
Tbeproblemoffunctionalpatbology,consideredfromtbeper-
spectiveofconsciousactivityrelatedtotbepsycbopbysiologi-
cal levels ituses, seems intimatelyconnected witb tbat of
education. Astbeconsequenceofasensory, active,emotional
education,badly done ornotdone,iturgentlycallsforare-
education.Voreandmoretbeideaofbealtbornormalityceases
toappearastbatofconformitytoanouteridea(atbleteinbody,
bachelier [bcee graduate]inmind). |t takes its placeintbere-
lationbetweentbeconscious|anditspsycbopbysiologicalor-
ganisms, itisrelativistandindividualist[ 1 7, 49].
Ontbeseproblemsofpbysiologyandcomparativepatbologywe
areforcedtocontentourselveswitbfewdocuments,but,altbougb
tbeirautborsbavefolloweddissimilarpurposes,tbeyleadone,sur-
prisingly, totbe same conclusions. |orak,wbo sougbt knowledge
abouttbebeginningofdiseasesintbestudyoffunctionalrbytbms
1 66
NORM AND AVERAGE
andtbeirdisturbances,bas demonstratedtberelationsbipbetween
kindsofexistenceandtbecurvesofdiuresisandtemperature(slow
rbytbms),pulseandrespiration(fastrbytbms).YoungCbinesebe-
tween1 8 and25 baveanaverageurinarydiscbargeof0. 5 cmper
minute witboscillationsfrom0. 2 to0. 7 wbileforLuropeanstbis
discbarge is 1 cmwitboscillationsfrom 0. 8 to 1 . 5 . |orakinter-
prets tbis pbysiologicalfactintermsof tbe combined in|luences
ofgeograpbyandbistoryinCbinesecivilization.Accordingtobim,
two outof tbis complexof induences are fundamental. tbe na-
ture of tbe diet(tea, rice, youngvegetables) andtbe nutritive
rbytbms determinedbyancestralexperience, tbemodeof ac-
tivitywbicbmoresoinCbinatbanintbeWestrespectstbeperi-
odic developmentof neuromuscularactivity. Westernsedentary
babits bave a barmful effectontberbytbmof liquids. Tbis dis-
turbancedoesnotexistinCbina,wberetbetasteforwalking'in
tbepassionatedesiretoloseoneselfinnaturebasbeenpreserved
9+, 46].
Tbestudyofrespiratoryrbytbm(rapidrbytbm)sbowsupvari-
ationsintbeneed foractivityrelatedtodevelopmentandtoan-
kylosis. Tbisneedisitselfrelatedtonaturalorsocialpbenomena
wbicbpunctuatebumanwork. >incetbeinventionofagriculture,
tbe solar day basframedtbeactivityof most men. Urban civili-
zationandtbedemandsofamoderneconomybavedisturbedtbe
greatpbysiologicalcyclesofactivityofwbicbonlytracesremain.
Ontotbesefundamentalcyclesaregraftedsecoudarycycles.Wbile
cbanges inposition determine secondarycycles intbevariations
of tbepulse, itistbe psycbic in|luences wbicb predominate in
breatbing.breatbingspeedsuponawakening,assoonastbeeyes
opento tbe ligbt.
Toopentbeeyesmeanstbattbeattitudeoftbestateofwake-
fulness isalreadybeingassumed,itmeans tbattbefunctional
rbytbmsarealreadybeingorientedtowardtbedeploymentof
neuromotoractivityandtbesupplerespiratorymnctionisready
tomeet tbeoutsideworld.itreactsimmediatelytotbeopen-
ingof tbeeyelids[94, 62].
becauseoftbebematosisitguarantees,tberespiratoryfunction
issoimportantfortbeexplosiveorsustaineddeploymentofmus-
cularenergytbataverysubtleregulationmustdetermineinstan-
taneously considerable variations intbevolumeof inbaledair.
Respiratoryintensitytbusdependsontbequalityofourattacksor
ourreactionsinourcon|lict witbtbe environment. Respiratory
rbytbmisamnctionofourawarenessofoursituationintbeworld.
One would expect tbat |orak's observations would lead bim
to offer informationabouttberapeuticsandbygiene. Andtbis is
infactwbatbappens.>incepbysiologicalnormsdehnelessbuman
nature tban buman babitsastbeyrelate to tbekinds, levels and
rbytbmsoflife,everydietaryrulemusttaketbesebabitsintoac-
count. Uereiagoodexample of tberapeuticrelativism.
Cbinesewomennurset
]
eircbildrenduringtbeirhrsttwoyears
oflife.Afterbeingweaned,tbecbildrenwill neverdrinkmilk
again.Cow'smilkisconsideredanunsuitableliquid,goodonly
forpigs. | baveoftentriedcow'smilkwitbpatients suffering
fromnepbritis. Urinaryankylosis was produced immediately.
byputtingtbepatientonadietofteaandrice,agoodurinary
crisis reestablisbedtbe eurbytbmia [94, 99].
Asfortbecausesofmnctionaldiseases,ifconsideredattbeironset,
tbeyarealmostalldisturbancesofrbytbms,arbytbmiasstemming
fromfatigueoroverwork,tbatis,fromanyexerciseexceedingtbe
properadjustmentsoftbeindividual'sneedstotbeenvironment
[94, 86].
1 68
NORM AND AVERAGE
|tisimpossibletomaintainatypewitbinbismarginoffunc-
tional availability. | believe tbe bestdehnitionofmanwould
beaninsatiablebeing,i . e. , onewboalways exceedsbisneeds
[94, 89].
Uereisagooddehnitionofbealtbtbatpreparesustounderstand
its relationsbip to disease.
WbenVarcel Labb studiedtbeetiology of nutritional dis-
easesprincipallywitbregardtodiabetes, be cametoanalogous
conclusions.
Nutritionaldiseasesarenotorganicbutfunctionaldiseases . . . .
Lefects indietplayanimportantrole intbeoriginof nutri-
tionaldisturbances. . . . Obesityistbemostnequentandtbesim-
plestoftbesediseasescreatedbytbesit upbrinsins [education
morbide] providedbyparents. . . . Vostnutritionaldiseasesare
inevitable. . . . | amspeakingaboveallofbadbabitsoflifeand
dietwbicbindividuals must avoidandwbicb parents already
ahlictedwitb nutritional disturbances mustavoid passing on
totbeircbildren[65, / 0. 50/].
Wecanonlyconcludetbattoconsidertbeeducationoffunctions
asatberapeuticmeasure, asLaubryandbrosse, |orakandVar-
cel Labb do, istoadmit tbatfunctionalconstantsare babitual
norms.Wbatbabitbasmade,babitunmakesandremakes.|fdis-
easescanbedehnedasdefectsintermsotbertbanmetapborical,
tbenpbysiologicalconstantsmustbedehnable,otbertbanmeta-
pborically, asvirtuesintbeoldsenseoftbeword,wbicbblends
virtue,powerandfunction.
|tmustbe saidtbat >orre's researcbon tberelationsbip be-
tweenman'spbysiologicalandpatbologicalcbaracteristicsandcli-
mates, diets andbiological environment, bas an aim completely
differentfromtbeworkswebavejustcited. but
batisnotewor-
tbyistbatalltbesepointsofviewarejustib edandtbeirinsigbts
conhrmed in >orre's work. Ven's adaptation to altitude and its
bereditarypbysiologicalaction[ 1 09, 51 ] ; tbeproblemsoftbeef-
fectsof ligbt[ 109, 54]; tbermictolerance[ 109, 58]; acclimatiza-
tion[ 109, 94]; dietattbeexpenseofalivingenvironmentcreated
byman [ 1 09, 120]; geograpbical distribution andtbe plastic ac-
tionofdiets[109, 245, 275]; andtbeareaoftbeextensionofcom-
plexpatbogens(sleepingsickness,malaria, plague,etc. )[ 109, 291 ]:
all tbese questions are treatedwitba great dealof precision,
breadtbandconstantcommonsense.Certainlywbatinterests>orre
above all is man's ecology, tbe explanation of tbe problems of
buman settlement. but in tbe end, as all tbeseproblems lead to
problemsofadaptation,weseebowageograpber'sworkisofgreat
interestforametbodologicalessayonbiologicalnorms. >orresees
veryclearlytbeimportanceoftbecosmopolitanismoftbebuman
species for a tbeory of tbe relative instability of pbysiological
constants.tbeimportanceoffalseadaptiveequilibriumstatesto
explain diseases ormutations , tbe relationof anatomical and
pbysiologicalconstantstocollectivediets,wbicbbeveryj udiciously
qualib esasnorms[ 1 09, 249]; tbeirreducibility,topurelyutilitar-
ianreasons,of tecbniquesforcreatingareallybumanambience,
tbeimportance,intermsoftbeorientationofactivity, oftbein-
directactionoftbebumanpsycbeoncbaracteristicslongconsid-
erednaturalsucbasbeigbt,weigbt,collectivediatbeses. byway
ofconclusion,>orreisinterestedinsbowingtbatman, takencol-
lectively, issearcbingforbis 'functional optima, tbat is, for
values of eacb of tbe elements in bis surroundings for wbicba
particularfunctionisbestcarriedout.|bysiologicalconstantsare
not constants in tbe absolute senseof tbe term. !or eacb func-
tionand set of functions tbere is a marginwberetbegroup or
speciescapacityforadaptationcomesintoplay.Tbeoptimalcon-
1 70
NORM AND AVERAGE
ditionstbusdetermineazoneforbumansettlementwberetbeuni-
formityofbumancbaracteristicsexpressesnotonlytbeinertiaof
adeterminismbutalso tbestability ofa resultmaintainedby an
unconsciousbutrealcollectiveeffortl09,4l l 6]. |tgoeswitb-
outsayingtbat we are pleasedto seeageograpberbringing tbe
solidityof bis results of analysis to bearinsupportingoursug-
gested interpretation of biological constants. Constants are pre-
sentedwitbanaveragefrequencyandvalueinagivengroupwbicb
gives tbem tbe value of normal and tbisnormal istruly tbe ex-
pressionofanormativity.Tbepbysiologicalconstantistbeexpres-
sionofapbysiologicaloptimumingivenconditionsamongwbicb
wemustbearinmindtbosewbicbtbelivingbeingingeneral,and
homo faber in particular,give tbemselves.
becauseoftbeseconclusionswewoulddiffersomewbatfrom
|alesandVonglondininterpretingtbeirveryinterestingdataon
tberateofglycemiainAfricanblacks9zbis]. Out of84 brazzaville
natives, 66%sbowedbypoglycemia,oftbese, 19%wentfrom
0. 90gto0. 7gandz7%werebclow0. 7g.Accordingtotbese
autborstbeblackmustbegenerallyconsideredasbypoglycemic.
|nanycasetbe blackwitbstandsbypoglycemiaswbicbwouldbe
consideredgrave ifnotmortal ina Luropean, witboutapparent
disturbanceandespeciallywitbouteitberconvulsionsorcoma.Tbe
causesoftbisbypoglycemiawouldbavetobesougbtincbronic
undernourisbment,cbronicandpolymorpbous intestinalparasit-
ism andmalaria.
Tbesestatesareontbeborderbetweenpbysiologyandpatbol-
ogy. !rom tbe Luropean point ofviewtbeyare patbological,
from tbe indigenous point of viewtbeyare so closely linked
totbeblack'sbabitualstatetbatwereitnotfortbecompara-
tivetermsoftbewbite,itcouldalmostbeconsideredpbysio-
logical9zbis, /6 /].
1
7
1
WedehnitelytbinktbatiftbeLuropeancanserveasanorm, itis
onlytotbeextenttbatbis kindoflifewillbeabletopass asnor-
mative. To Lefrou as well as to |ales and Vonglond tbe black's
indolenceappearsrelatedtobisbypoglycemia[76 bis, 2 78; 92 bis,
767]. Tbese lastautbors say tbat tbe blackleadsa life in accor-
dance witbbis means. but could itnotjustas well be said tbat
tbe blackbaspbysiologicalmeansinaccordance witbtbelife be
leads?
Tbe relativity of certain aspects of anatomic and pbysiologica|
norms and consequently of certainpatbological disturbances as
tbeyrelatetoways oflifeandknowledgeoftbeworld,isappar-
entnotonlyintbecomparisonofetbnicandculturalgroupswbic
canbeobservednow,butalsointbecomparisonoftbesepresent-
daygroupsandearliergroupswbicbbavedisappeared.Ofcourse,
paleopatbologybasevenfewerdocumentsatitsdisposaltbanpa-
leontology orpaleograpby, nevertbelesstbeprudentconclusions
wbicbcan bedrawnfrom itdeserve to besbown.
|ales,wbobasmadeagoodsyntbesisofworksoftbiskindin
!rance,borrowedadebnitionoftbepaleopatbologicaldocument
fromRoyC. Voodie,namely,everydeviationfromtbebealtbystate
of tbebodywbicbbasleftavisibletraceontbefossilizedskele-
ton [92, 1 6; in |ales 92 see a list of Voodie's works, andfor a
popularizationseeH. de\arigny,La mort et la biologie, |aris, Alcan,
1 926]. |ftbe sbarpened |lints andartof >tone Agementell tbe
storyoftbeirstruggles,tbeirworksandtbeirtbougbt,tbeirbones
calltomindtbebistoryof tbeirpains [92, 307]. |aleopatbology
allowsonetoconceiveoftbepatbologicalfactinbumanbistory
asafactofsymbiosis,intbecaseofinfectious diseases (andtbis
concernsnotonlymanbuttbelivingingeneral),andasafactof
tbeculturallevelorkindoflife,intbecaseofnutritionaldiseases.
1
7
2
NORM AND AVERAGE
Tbediseases suffered byprebistoricmenturnedup inverydif-
ferentproportionsfromtbosewbicbdiseasesnowoffer for con-
sideration.\alloispointsouttbatin!rencbprebistoryaloneeleven
cases of tuberculosis turn up out of several tbousand skeletons
studied l l 1, 6/2]. |ftbe absenceofrickets,adiseasecausedby
vitamin 0 dehciency, is normalin anage wbere raw or barely
cookedfoodswereconsumed l l 1, 6 /2], tbeappearanceoftootb
decay,unknowntotbehrstmen, signihescivilizationintermsof
tbeconsumptionofstarcbesandcookingfoodwbicbbringsinits
wake tbe destruction of vitamins necessaryfor tbe assimilation
ofcalcium l l 1, 6//]. Likewise,osteoartbritiswasmucbmorefre-
quentintbe>toneAgeandsubsequentepocbstbanitisnow,and
tbismustprobablybeattributedtoaninadequatedietandacold,
bumidclimate,sinceitsdiminutioninourdaymeansbetterdiet
and amorebygienicwayof life l l 1, 6/2].
Wecaneasilyimagine tbedifhcultyofastudy wbicb lacks all
tbediseaseswboseplasticordeformingeffectsfailedtoleavetraces
ontbe skeletons of fossil menor tbose dugup intbe course of
arcbaeological excavations. Wecanimaginetbe prudence neces-
saryindrawingconclusionsfromtbisstudy. buttotbeextenttbat
we can speak of a prebistoricpatbology, we sbould alsobeable
tospeakofaprebistoricpbysiologyj ustaswespeak,witbouttoo
mucbinaccuracy, ofa prebistoricanatomy. Uereagaintbe rela-
tionsbipbetweentbebiologicalnormsoflifeandtbebumanen-
vironmentseemstobebotbcauseandeffectof men's structure
andbebavior. |alespointsout,witbcommonsense,tbatifboule
coulddeterminetbattbeVanofLaCbapelle-aux->aintsacom-
pletefossil skeleton foundin l90in a cave inCorrze, !rance]
typihes tbe classical anatomy of tbe Neandertbal race, we by
contrast]couldseeinbimwitbouttoomucbcomplacency,tbemost
perfecttypeofpatbologicalfossilman,sufferingfromalveolarpy-
orrbea, bilateralcoxalfemoralosteoartbritis,cervicalandlumbar
1
7 3
spondylosis,etc.Yes, ifweweretoignoretbedifferencesofcos-
micmilieu,tecbnicalequipmentandwayoflifewbicbmaketbe
abnormal oftodaytbe normal of yesterday.
|fitseemsdifhculttodisputetbequalityoftbeobservationsused
above,onemigbtwanttoquestiontbeconclusionstowbicbtbey
leadconcerningtbepbysiological signihcance offunctionalcon-
stantsinterpretedasbabitualnormsoflife. bywayof response,
itsbouldbepointedouttbattbesenormsarenottbeproductof
individualbabitswbicbacertainindividualcouldtakeorleaveas
bepleased. |fweadmitman'sfunctionalplasticity, linkedinbim
tovitalnormativity,wearenotdealingwitbeitberatotalandin-
stantaneousmalleabilityora purely individual one. To propose,
witballsuitablereservations,tbatmanbaspbysiologicalcbarac-
teristics relatedtobisactivity, doesnotmeanallowingeveryin-
dividualtobelieve tbat be will beable to cbange bisglycemia or
basalmetabolismbytbeCoumetbodofautosuggestion]oreven
byemigrating. Wbat tbespeciesbas workedout overtbecourse
ofmillenniadoesnotcbangeinamatterofdays.\oelkerbassbown
tbatbasalmetabolismdoesnotcbangeasonegoesfromUamburg
to |celand. benedictmakes tbesame point concerning tbemov-
ingof NortbAmericanstosubtropicalregions. butbenedictbas
ascertainedtbattbemetabolismofCbinesepermanentlyresiding
intbeUnited>tatesislowertbantbeAmericannorm. Cenerally
speaking, benedict bas establisbed tbat aboriginal] Australians
(kokatas)bavealowermetabolismtbanwbitesof tbesameage,
weigbtandbeigbtlivingintbeUnited>tates,tbatinversely| ndi-
ans(Vayas)baveabigbermetabolismwitbaslowedpulseandper-
manentlyloweredarterialpressure.Wecanconcludewitbkayser
and LontcbelI.
1
74
NORM AND AVERAGE
|tseems a proven fact tbatwitbmantbe climaticfactorbas
nodirect effectonmetabolism, itisonlyinaveryprogressive
mannertbatclimate,bymodifyingtbemodeoflifeandallow-
ingtbeconsolidationofspecialraces,basanylastingactionon
basal metabolism 6z, 26].
|nsbort,toconsidertbeaveragevaluesofbumanpbysiologi-
calconstantsastbeexpressionofvitalcollectivenormswouldonly
amounttosayingtbattbebumanrace, ininventingkindsoflife,
inventspbysiologicalbebaviorsattbesametime.butaretbekinds
of life notimposed?Tbe works of tbe !rencb scbool of buman
geograpby >orreand\idaldelablacbe]bavesbowntbattbereis
nogeograpbicaldestiny. Lnvironmentsoffermanonlypotentiali-
tiesfortecbnicalutilizationandcollectiveactivity.Cboicedecides.
Let usbe cleartbat itisnot a question of anexplicitandcon-
sciouscboice. butfrom tbemomentseveralcollectivenormsof
lifearepossibleinagivenmilieu,tbeoneadopted,wboseantiq-
uitymakesitseemnatural,is,intbehnalanalysis,tbeonecbosen.
|ncertain cases, bowever, itispossible tosbowtbeinlluence
ofanexplicitcboice ontbedirectionof somepbysiological be-
bavior. Tbis is tbe lessonwbicbemerges from observations and
experimentsrelatedtotemperatureoscillationsintbebomeotber-
mic animal, to circadianrbytbm.
Tbeworksofkayserandbiscollaboratorsontbepigeon'scir-
cadianrbytbmestablisbedtbattbedayandnigbtvariationsintbe
central temperature oftbebomeotbermicanimalareapbenom-
enonofvegetative life subordinatedtorelationalfunctions.Tbe
nocturnalreductionofexcbangesistbeeffectoftbesuppression
of ligbt andsound stimulants. Tbe circadianrbytbmdisappears
inapigeonmadeblindexperimentallyandisolatedfrombisnor-
malbretbren.Tbereversaloftbeorderintbeligbtdarksucces-
sionreversestberbytbmafterafewdays.Tbecircadianrbytbm
1
7
5
is detenninedbya conditioned re|lex maintainedbytbe natural
alterationofdayandnigbt.Asfortbemecbanism,itdoesnotcon-
sistinanocturnalbypoexcitabilityoftbetbennoregulatorycen-
tersbutintbesupplementaryproductionbydayofanamountof
beatwbicbisaddedtotbecalorihcation,evenlyregulateddayand
nigbtbytbetbennoregulatorycenter.Tbisbeatdependsonstim-
ulationcomingfromtbeenvironmentaswellasontbetempera-
ture.itincreaseswitbcold.Wbenallbeatproducedbymuscular
activityissetaside,tberisewbicbgivescircadiantemperatureits
rbytbmic aspectmustberelatedonlytotbe increaseinposture
tonusbyday. Tbebomeotbennicanimal'scircadiantemperature
rbytbmis tbe expressionof a variation in attitude oftbe entire
organismwitbrespecttotbeenvironment.Lvenwbenatresttbe
animal'senergy, ifitisstimulatedbytbeenvironment,isnoten-
tirelyat its disposal, one part beingmobilizedintonic attitudes
ofvigilanceandreadiness. Tbestateofwakefulnessisabebavior
wbicb,evenwitboutalanns,doesnotworkwitboutcosts[60; 61 ;
62; 63].
Tbeseconclusionssbedagreatdealofligbtonsomeobserva-
tionsandexperimentsconcerningman,resultswbicbbaveoften
seemedcontradictory. Vosso, ontbe one band and benedicton
tbeotber,wereunabletosbowtbattbenonnaltemperaturecurve
dependsonenvironmental conditions.butin1 907 Toulouseand
|ironstatedtbattbeinversionoftbeconditionsoflife(noctur-
nal activityanddiurnal rest) brougbt about tbe completeinver-
sion of tbe circadian temperature rbytbm in man. Uowdo we
explaintbiscontradiction?benedictbadobservedsubjectswbowere
unaccustomedtonocturnallife andwboatrestboursduring tbe
dayledtbenonal lifeoftbeirenvironment.Accordingtokayser,
aslongasexperimentalconditionsdonotequal tbose ofa com-
plete inversionof tbemode oflife, itisnotpossibletodemon-
strateadependencebetweentberbytbmandtbeenvironment.Tbe
NORM AND AVERAGE
followingfactsconhrmtbisinterpretation. |ntbesuckling,circa-
dianrbytbmappearsprogressively,paralleltotbeinfant'spsycbic
development.Attbeageofeigbtdaystbedivergenceintempera-
tureis0.09",athvemontbs,0. 17",betweentwoandhveyears,0. 9".
Certain autbors, Osborne and \oelker, bave studied circadian
rbytbmintbecourseoflongtripsandtbeystatetbattbisrbytbm
followstbelocaltimeexactly6l ,304-306]. Lindbardpoints out
tbatduringa Lanisb expedition toCreenlandin l9060, circa-
dianrbytbmfollowedlocal time andtbatasfarnortbas 76"+6'
anentirecrew,aswellastbetemperaturecurve,succeededinsbift-
ingtotbetwelve-bour'day. Completereversalcouldnotbeob-
tainedbecauseof tbepersistenceof normal activity.`
Uere tben is an example of a constant related to tbe condi-
tions of activity, to a collectiveandeven individualkindof life,
wboserelativity expressesnormsofbumanbebaviorintermsof
are|lexconditionedto variable disengagement. Uuman will and
buman tecbnology canturn nigbt into daynotonlyintbeenvi-
ronmentwberebumanactivityunfolds,butalsointbeorganism
itselfwboseactivityconfrontstbeenvironment.Wedonotknow
towbatextentotberpbysiologicalconstants,wbenanalyzed,could
appearin tbe same way as tbe effectof a supple adaptationof
bumanbebavior.Wbatmatterstousislesstofurnisbaprovisional
solutiontbantosbowtbataproblemdeservestobeposed. |nany
case,intbisexample we tbinkwe
are usingtbeterm'bebavior
correctly. !romtbemomenttbeconditionedre|lexsetstbecere-
bral cortex's activityintooperation, tbeterm're|lexmustnot
be takenin its strict sense. We aredealingwitba global, not a
segmented, functional pbenomenon.
bywayofsummary, wetbinktbattbeconceptsofnormandav-
eragemustbeconsideredastwodifferentconcepts.itseemsvain
1 77
totryto reduce tbemtoonebywipingouttbeoriginalityof tbe
brst. |tseemstoustbatpbysiologybas bettertodotbantosearcb
foranobjectivedehnitionoftbenormal,andtbatistorecognize
tbeoriginalnormativecbaracteroflife.Tbetrueroleofpbysiol-
ogy, of sufb cient importance and difhculty, would tben beto
determineexactlytbecontentoftbenormstowbicblifebassuc-
ceededin hxingitselfwitboutprejudicingtbepossibilityorim-
possibilityofeventuallycorrectingtbesenorms.bicbatsaidtbat
animalsinbabittbeworldwbileplantsbelongonlytotbeirplace
oforigin.Tbisideaisevenmoretrueofmentbanofanimals.Van
bassucceededinlivinginallclimates,beistbeonlyanimal witb
tbepossibleexceptionofspiders wboseareaofexpansionequals
tbeareaoftbeeartb. butaboveallbeistbeanimalwbo,tbrougb
tecbnology,succeedsinvaryingeventbeambienceofbisactivity
ontbespot,tberebysbowingbimselfnowastbeonlyspeciesca-
pable of variation l l+]. | sitabsurdto assume tbat in tbe long
runman'snaturalorganscanexpresstbeinduenceoftbeartihcial
organs tbrougbwbicbbebas multipliedandstill multiplies tbe
power of tbe hrst?Weare awaretbat tbe beredityof acquired
cbaracteristicsseemstomostbiologiststobeaproblemwbicbbas
beenresolvedintbenegative.Wetaketbelibertyofaskingour-
selveswbetbertbetbeoryoftbeenvironment'sactionontbeliv-
ingbeingwerenotontbevergeofrecoveringfromlongdiscredit.
26
*
True, itcouldbeobj ected tbat in tbiscasebiological constants
wouldexpresstbeeffectof externalconditionsof existence on
tbelivingbeingandtbatoursuppositionsconcemingtbenormative
valueofnatural]constantswouldbedeprivedofmeaning.Tbey
wouldcertainlybesoi variablebiologicalcbaracteristicsexpressed
cbangeofenvironment,asvariationsinaccelerationduetoweigbt
arerelatedtolatitude. butwerepeattbatbiologicalfunctionsare
unintelligibleasobservationrevealstbemtous,iftbeyexpressonly
statesof amaterialwbicbispassivebefore cbanges intbe envi-
1
7
8
NORM AND AVERAGE
ronment. |n facttbe environment of tbe livingbeingisalso tbe
workof tbelivingbeingwbo cbooses to sbield bimself from or
submitbimselftocertainin|luences.We cansayoftbeuniverse
ofeverylivingtbingwbatReiningersaysoftbeuniverseofman.
'UnserWeltbildistimmerzugleicbeinWertbild,
, ,
'ourimageof
tbe world is always a display of values as well.
1
79
CHAPTER | \
Dis eas e, Cure, Heal t h
|ndistinguisbinganomalyfromtbepatbological state, biological
varietyfromnegativevitalvalue,webave,ontbewbole,delegated
tberesponsibilityforperceivingtbeonsetofdiseasetotbeliving
beingbimself, considered inbisdynamicpolarity. Tbatisto say,
indealingwitbbiologicalnorms,one mustalwaysrefertotbein-
dividualbecausetbisindividual,asColdsteinsays,canb ndbim-
self'equaltotbetasksresultingfromtbeenvironmentsuitedto
bim [46, 265], butinorganicconditionswbicb, inanyotberin-
dividual,wouldbeinadequatefor tbesetasks. ]ustlike Laugier,
Coldsteinassertstbatastatisticallyobtainedaveragedoesnotallow
us to decide wbetber tbe individual beforeus isnormal or not.
Wecannot start from itinorder to discbarge ourmedical duty
towardtbeindividual. Wbenitcomestoasupra-individualnorm,
itisimpossibletodeterminetbe'sickbeing(Krnksein) astocon-
tent.buttbisisperfectlypossibleforanindividualnorm[46, 265,
272].
|ntbesameway, >igeristinsistsontbeindividualrelativityof
tbebiologicalnorm.|fwearetobelievetradition,Napoleonbad
a pulse of40 evenwbenbewasingoodbealtb' |f, witb40 con-
tractionsaminute,anorganismisuptotbedemandsimposedon
bim,tbenbeisbealtbyandtbenumberof40 pulsations,tbougb
truly aberrant in terms of tbe average numberof 70, is normal
fortbisorganism. >igeristconcludes,'wesbouldnotbecontent
witbestablisbingtbecomparisonwitbanormresultingfromtbe
average, but ratber, insofar as it is possible, witbtbe conditions
of tbe individual examined [1 07, J08].
|ftbenormaldoesnotbavetberigidityofafactofcollective
constraintbutratbertbedexibilityofanormwbicbistransformed
inits relationtoindividualconditions,itiscleartbat tbe bound-
arybetweentbenormalandtbepatbologicalbecomesimprecise.
buttbisinnowayleadsustocontinuitybetweenanormalanda
patbological identical in essence save forquantitative variations,
nortoarelativityofbealtbanddiseasesoconfusingtbatonedoes
not know wbere bealtbends and disease begins. Tbe borderline
betweentbenormalandtbepatbologicalisimprecise forseveral
individualsconsideredsimultaneouslybutitisperfectlyprecisefor
oneand tbe sameindividualconsideredsuccessively. |norderto
benormativeingivenconditions,wbatisnormalcanbecomepatbo-
logical inanotbersituationifitcontinuesidenticalto itself. |t is
tbeindividualwbois tbej udgeof tbis transformationbecauseit
isbewbosuf|ers fromitfromtbeverymomentbefeels inferior
to tbe tasks wbicb tbe newsituationimposes on bim. Tbe cbil-
dren'snanny, wbo perfectlydiscbarges tbeduties of berpost, is
aware of berbypotensiononlytbrougbtbeneurovegetativedis-
turbances sbe experienceswbensbe is taken onvacation in tbe
mountains. Of course, nooneisobligedtoliveatbigbaltitudes.
butoneissuperiorifonecandoit,for tbiscanbecomeinevita-
bleatanytime.Anormoflifeissuperiortoanotbernormwben
itincludeswbattbelatterpermitsandwbatitforbids.butindif-
ferentsituationstbere aredifferentnorms,wbicb,insofarastbey
aredifferent,areall equal, andsotbeyareallnormal. |ntbisre-
gard Coldstein pays agreat deal of attention to tbe sympatbec-
tomy experiments carried out on animals by Cannon and bis
1 8 2
DI SEASE, CURE, HEALTH
collaborators.Tbeanimals,wbosetbermoregulationbaslostallits
usual|lexibilityandwboareincapableofstrugglingfortbeirfood
oragainsttbeirenemies,arenormalonlyinlaboratorysurround-
ingswberetbeyaresbelteredfromtbebrutalvariationsandsud-
den demands of adapting to tbe environment [46, 2 76-277].
Uowever, tbisnormalisnotcalledtrulynormal. !ori tisnormal
fortbe nondomesticatedand nonexperimentally prepared living
beingtoliveinanenvironmentwbere|luctuationsandnewevents
are possible.
Asaconsequencewemustsaytbattbepatbologicalor abnor-
malstatedoesnotconsistintbeabsenceofeverynorm. Lisease
isstillanormoflifebutitisaninferiornormintbesensetbatit
toleratesnodeviationfromtbeconditionsinwbicbitisvalid,in-
capableasitisofcbangingitselfintoanotbernorm.Tbesickliv-
ingbeingisnormalizedinwell-dehnedconditionsof existenceand
baslostbisnormativecapacity, tbecapacitytoestablisbotbernorms
inotberconditions. |t bas long beennoted tbat intubercularos-
teoartbritisoftbeknee,articulationisfrozeninafaultyposition
(tbeso-calledbonnetposition).Nlatonwastbehrsttogiveitits
still classic explanation.
|tisraretbattbelimbmaintainsitsusualstraigbtness. |ndeed,
inordertorelievetbeirsuffering,tbesickinstinctivelyputtbem-
selvesinanintermediarypositionbetween|lexion andexten-
sion, wbicb causes tbe muscles to exert less pressure on tbe
articularsurfaces[ 88, 1/, 209].
Tbebedonicandconsequentlynormative signihcanceof patbo-
logicalbebaviorisperfectlyperceivedbere. Articulationrealizes
itsmaximumcapacityundertbe in|luenceofmuscularcontrac-
tionandstrugglesspontaneouslyagainstpain.Tbepositionissaid
to bedefective only in relation to an articulation practice wbicb
admits ofalltbe possiblepositionssaveanterior|lexion. but be-
neatbtbisfaulttbereisanotbernorm,inotberanatomicandpbysi-
ological conditions, wbicb lies bidden.
Tbeclinicalobservationofmenwitbbeadwounds,systematically
carriedoutduringtbe 1914-1 91 8 war,allowed Coldstein tofor-
mulatesomegeneralprinciplesaboutneurologicalnosologywbicb
can be appropriately summarized bere.
|fitistruetbatpatbologicalpbenomenaaretberegularmodi-
hcationsof normal pbenomena, tbeformer cansbedsomeligbt
ontbelatteronlyontbe condition tbattbeoriginalmeaningof
tbismodihcationbasbeengrasped.Wemustbeginb rstbyunder-
standingtbe patbologicalpbenomenonasrevealingamodi hed
individualstructure.Onemustalwaysbearinmindtbetransfor-
mationoftbesickperson'spersonality. Witbouttbisonerunstbe
riskofignoringtbefacttbattbe sick person,eventbougbcapa-
ble of reactions similarto tbosepreviouslypossible tobim, can
arriveattbesereactionsbyverydifferentpatbs.Tbesereactions,
wbicbareapparentlyequivalenttopreviousnormalreactions,are
nottberesidueofpreviousnormalbebavior,tbeyarenottbere-
sultof animpoverisbment or diminution, tbeyare nottbenor-
malmodeoflifeminussometbingwbicbbasbeendestroyed.tbey
arereactionswbicbnevertumupintbenormalsubjectintbesame
form and in tbe same conditions [45].
|nordertodebneanorganism'snormalstate,prefrential behavior
mustbetakenintoaccount,inordertounderstanddisease,cata
strophic reaction must be takenintoaccount. bypreferential be-
bavioritmustbeunderstoodtbatamongalltbereactionsofwbicb
anorganismis capable under experimental conditions, onlycer-
tainonesareusedastbosepreferred. Tbismodeoflife,wbicbis
cbaracterizedbyasetofpreferredreactions,istbatinwbicbtbe
livingbeingrespondsbesttotbedemandsofbisenvironmentand
livesinbarmonywitbit,itistbatwbicbincludestbemostorder
andstability, tbeleastbesitation,disorderandcatastropbicreac-
tions +6, 24, +9, i 3ii34]. |bysiological constants (pulse, ar-
terialpressure,temperature,etc. )expresstbisorderedstabilityof
bebaviorforanindividualorganisminwell-dehnedenvironmen-
tal conditions.
|atbologicalpbenomenaaretbeexpressionoftbefacttbattbe
normalrelationsbipsbetweenorganismandenvironmentbave
beencbanged tbrougb a cbange of tbe organism, and tbat
tberebymanytbingswbicbbadbeenadequatefortbenormal
organism are no longer adequate fortbe modihed organism.
Liseaseissbockanddangerforexistence.Tbusadebnition
ofdiseaserequiresaconception of the individual nature as a start
in8 point . Liseaseappearswbenanorganismiscbangedinsucb
a way tbat, tbougb in its proper, 'normal milieu, itsuffers
catastropbicreaction.Tbismanifestsitselfnotonlyinspecihc
disturbancesofperformance,correspondingtotbelocusoftbe
defect, but in quite general disturbancesbecause, aswe bave
seen,disorderedbebaviorinanybeldcoincidesalwayswitbmore
orless disorderedbebavioroftbewboleorganism+6,Lnglisb
edition, p. +1z].
WbatColdsteinpointedoutinbispatientsistbeestablisbment
ofnewnormsof life bya reduction intbeleveloftbeiractivity
asrelatedtoanewbutnarrowed environment.Tbenarrowingof
tbeenvironmentinpatientswitbcerebrallesionscorrespondsto
tbeirimpotenceinrespondingtotbedemandsoftbenormal,tbat
is,previousenvironment. |nanenvironmentwbicbisnotrigidly
protected,tbesepatientswouldknowonlycatastropbicreactions,
insofarastbepatientdoesnotsuccumbtotbedisease,beiscon-
cernedwitb escapingfromtbeanguisbof tbe catastropbicreac-
tions.Uencetbemaniafororderandtbemeticulousnessoftbese
patients,tbeirdownrigbttasteformonotonyandtbeirattacbment
to a situation tbey know tbey can dominate. Tbe patient issick
becausebecanadmitofonlyonenorm.Touseanexpressionwbicb
bas already been veryusefultous,tbe sickmanisnotabnormal
because of tbe absence of a norm but because of bis incapacity
to be normative.
Witbtbisviewofdiseaseweseebowfarwearefromtbecon-
ceptionofComteorbernard. Liseaseisapositive,innovativeex-
perience in tbe living being and notj usta fact of decrease or
increase.Tbecontentoftbepatbologicalstatecannotbededuced,
savefora differenceinformat, from tbe content of bealtb, dis-
easeisnotavariationontbedimensionofbealtb,itisanewdi-
mensionoflife. Uowevernewtbeseviewsmayseemtoa!rencb
public, "tbeymustnotmakeoneforgettbatinneurologytbeyare
tbe outcome of a longandfertileevolution of ideas begun by
Uugblings ]ackson.
]acksonrepresentsdiseaseoftbenervoussystemof tberela-
tional life asdissolutionsofbierarcbicalfunctions.Lverydisease
correspondstoalevelintbisbierarcby. |neveryinterpretationof
patbologicalsymptomstbenegativeaswellastbepositiveaspect
mustbeconsidered.Liseaseisbotbdeprivationandcbange.Ale-
sionintbebigbernervoussystemfreestbelowerregulatoryand
controlcenters.Lesionsareresponsiblefortbelossofcertainmnc-
tions,buttbe disturbances of existingfunctionsmustbeattrib-
utedtotbeappropriateactivityofbencefortbinsubordinatecenters.
Accordingto ]ackson,nofactcanbavea negativecause. Neitber
alossnoranabsenceissufhcienttoproducedisturbanceinsen-
soryneuromotorbebavior[ 38]. ]ustas\auvenarguessaystbatpeo-
plesbouldnotbejudgedon tbe basisof wbattbey don'tknow,
so ]ackson proposes tbis metbodologicalprinciple wbicb Uead
1 86
calledtbegolden rule. 'Takenoteofwbattbepatientreallyun-
derstandsandavoidtermssucbasamnesia, alexia,worddeafness,
etc. [87, 759]. |tmeansnotbingto saytbata sickmanbaslost
bis speecb if one does not specify inwbattypicalsituationtbis
lackisperceptible. |faso-calledapbasicsubjectisasked.| syour
name ]obn?Ueanswers.No. butifbeisordered. >ayno,betries
andfails.Tbesamewordcanbesaid ifitbastbevalueofanin-
terjectionandcannotbesaidifitisavaluejudgment.>ometimes
tbe sickperson can't pronounce tbewordbutgetstotbe point
witbaperipbrasis. >uppose, saysVourgue,tbattbesickperson,
unable to name commonobjects, says, wben presentedwitban
inkwell.'Tbisiswbat|wouldcallaporcelainpotforboldingink,
does bebaveamnesia or not? [87, 760]
]ackson'simportantpointistbatlanguageand,generallyspeak-
ing,everyfunctionofrelationallife,iscapable ofseveraluses,in
particular,anintentionaluseandanautomatic use. |nintentional
actions, tbereisapreconceptionandactioniscarriedoutunder
control,itisdreamedofbeforebeingeffectivelyexecuted.Witb
language,twomomentsintbeelaborationofanintentionallyand
abstractly signihcant propositioncanbedistinguisbed. a subjec-
tivemoment,wben notions automatically come tomindandan
objectivemoment,wbentbeyareintentionallyarrangedaccord-
ingtoapropositionalplan.A. Ombredanepointsouttbattbedi-
vergence varies between tbese two momentsdepending on the
languages:
|ftberearelanguageswberetbisdivergenceisverypronounced,
aswecanseeintbehnalpositionoftbeverbinCerman,tbere
arealsolanguageswbereitisless. Voreover, ifwe remember
tbatfor]ackson tbeapbasiccanscarcelygobeyondtbeorder
oftbe subjectivemomentofexpression,we,likeArnold|ick,
can admit tbat tbegravityof tbe apbasic disordervariesac-
cordingtotbestructureoftbelanguageinwbicbtbesickper-
sontries to express bimself 9l , i -4].
|nsbort, ]ackson'sconceptionsmustserveasanintroductionto
Coldstein's.Tbesickpersonmustalwaysbejudgedintermsoftbe
situationtowbicbbe isreacting and tbe instrumentsof action
wbicbtbe environment itself offers bim language, in cases of
languagedisturbances.Tbereisnopatbologicaldisturbanceinit-
self.tbeabnormalcanbeevaluatedonlyintermsofarelationsbip.
butnomatterbowcorrecttberelationsbipestablisbedbetween
]ackson andColdsteinby Ombredane 9l], LyandRouart 1],
andCassirer zz],wesbouldnotignoretbeirprofounddifference
andColdstein'soriginality]ackson'sisanevolutionistpointofview
andbeadmits tbattbebierarcbicalcenters oftberelationalfunc-
tionscorrespondtodifferentevolutionarystages.Tberelationof
functionaldignityisalsooneof cbronological succession. bigber
andlaterfunctionsareidentihed. Tbeposteriorityof tbebigber
functionsexplains tbeirfragilityandprecariousness.Asdiseaseis
dissolution,itisalsoregression.Tbeapbasicorapraxicrediscov-
ersacbild'sorevenananimal'slanguageorgestures.Lisease, al-
tbougbitrepresentsacbangeinwbatremainsandisnotjusttbe
lossofwbatonebadpossessed,createsnotbing,ittbrowstbesick
person, as Cassirersays, 'astepbackwardontberoadmankind
badtoclearslowlybymeansof constanteffort zz, 66]. Now
ifitistrue,accordingtoColdstein,tbatdiseaseisanarrowedmode
oflife,lackingincreativegenerositybecauselackinginboldness,
itisnevertbelesstruetbatfortbeindividual,diseaseisanewlife,
cbaracterizedbynewpbysiologicalconstantsandnewmecbanisms
forobtaining apparently uncbangedresults. Uencetbiswarning,
already cited.
Onemustrefain fom believinn that the various attitudes possible
1 88
in a sick person represent
j
ust one kind of residue of normal behav
ior, wbat bas survived destruction. Tbe attitudeswbicbbave
survivedintbesickpersonnever arise in that form in the normal
person, notevenattbelowerstagesofitsontogenesisorpbylo-
genesis,as istoofrequentlyassumed. Liseasebasgiventbem
particularforms wbicb cannot bewell understoodunlessone
considers tbemorbidstate[45, 437].
|fitispossible, ineffect, tocomparetbegesticulationofasick
adultwitbtbatofacbild,tbeessentiallikeningofonetotbeotber
wouldleadtotbepossibilityofsymmetricallydebningtbecbild's
bebavioras tbat of a sickadult.Tbis wouldbeanabsurditybe-
causeitignorestbateagernesswbicbpusbestbecbiHtoraiseit-
selfconstantlytonewnorms,wbicbisprofoundlyatvariancewitb
tbe care to conserve wbicb directs tbe sick person inbis obses-
siveandoftenexbaustingmaintenanceoftbeonlynormsoflife
witbinwbicb befeelsalmostnormal, tbatis,inapositiontouse
anddominatebisownenvironment.
OntbisverypointLyandRouartbavegraspedtbeinadequacy
of]ackson's conception.
Witbregardtotbepsycbicfunctions,dissolutionproducesbotb
acapacitary regressionandaninvolutiontowardalowerlevel
ofpersonalityevolution. Capacitaryregressiondoesnotexactly
reproduceapaststagebutitcomes closetoit(language,per-
ceptual disturbances,etc. ). Tbe involutionoftbepersonality,
insofar as itispreciselytotalitarian, cannot be absolutelylik-
enedto a bistorical pbaseofontogenicor pbylogenic devel-
opment, forit bears tbemark of capacitary regression, and
furtbermore,asareactionalmodeoftbepersonalityat the ac
tual moment , itcannotgo backtoapastreactionalmode,not
evenifitiscutofffromitsbigbercircumstances.Tbisexplains
wby,foralltbeanalogiesdrawnbetweendeliriumandtbecbild's
mentalityorprimitivementality,wecannotconcludetbattbey
are identical [ 38, 32 7].
Again itwas ]ackson's i deas tbatguidedLelmas-Varsalet
ininterpretingresultsobtainedinneuropsycbiatrictberapyusing
electric sbock. but not content to distinguisb negative distur-
bancesintermsof dehciencyandpositive disturbances interms
oftbeliberationoftberemainingpartsas ]ackson did, Lelmas-
Varsalet, like Ly and Rouart, insists onwbat diseasesbows up
as abnormal , to put itexactly, as new. |n a brain subj ectedto
toxic, traumatic, infectious effects, modihcationsconsisting in
newconnectionsfromareatoarea,indifferentdynamicorienta-
tions,canappear.Awbolecell,wbicbisquantitativelyuncbanged,
iscapableof a newarrangement, of different 'isomeric con-
nections as isomers incbemistryare composedinanidentical
universalformula,butcertaincbainsofwbicbareplaceddifferently
inrelationtoa common nucleus. !romtbetberapeuticpointof
view,itmustbeadmittedtbatafterdissolving neuropsycbicfunc-
tions,tbecomaobtainedbymeansofelectricsbockmakespossible
a reconstruction wbicbisnotnecessarilytbe invertedreappear-
ance of stages in tbe previous dissolution. Tbe cure canj ust as
wellbeinterpretedasacbangefromonearrangementtoanotber,
as seen as a restitutionof tbe ioitial state [ 33]. |f we point out
tbeseveryrecentconceptions bere, it is tosbow tbe extentto
wbicbtbe ideatbat tbepatbologicalcannotbeIinearlydeduced
fromtbenormal,tendstoassertitself.Tbosewbowouldbeputoff
by Coldstein's language andmannerwillgo alongwitbLelmas-
Varsalet's conclusions precisely because of wbatwe personally
sballconsiderastbeirweakness,tbatis,tbevocabularyandimages
ofpsycbologicalatomism(building,quarrystone,arrangement,
arcbitecture, etc. )used to formulate tbem. but in spite of tbe
language,tbeirclinicalintegrityestablisbesfactswortbconsidering.
Onemayperbaps wisb to object tbatin expounding Coldstein's
ideas and tbeirrelation to ]ackson's, we aremovingintbe area
ofpsycbicratbertbansomaticdisturbancesandtbatwearede-
scribingfailuresinpsycbomotorutilizationratbertbanalterations
infunctionswbicbare,strictlyspeaking,pbysiological,andwbicb
constitutetbepointofviewwebadsaidwebadespeciallywanted
to assume. We could answer tbatwe bave tackled not only tbe
exposition but also tbe reading of Coldstein last andtbatall of
tbe examples of patbological facts we bave used to support our
bypotbesesandpropositions forwbicbColdstein'sideasareanen-
couragement and not an inspiration are borrowedfrom pbysi-
ological patbology. but we prefer to set out new, indisputably
pbysiological patbologicalworks wbose autbors owe notbingto
Coldsteinasfarastbetendenciesoftbeirresearcbareconcemed.
|n neurology it bad long been noted tbrougb clinical ob-
servationandexperimentationtbatseveringnervesinvolvessymp-
toms wbicbcannotbeadequatelyunderstood solelyinterms of
anatomical discontinuity. Luring tbe l 9l+l 9l war, a body of
factsconcernedwitbsecondarysensorimotor disturbances, fol-
lowinginjuriesandsurgicaloperations,againattractedattention.
Lxplanations of tbat time introduced anatomical substitutes,
pseudorestoration,andasoftenbappens,for wantofsometbing
better, pitbiatism. Lericbe's greatmeritistbatfrom l 9l 9on be
systematicallystudiedtbepbysiologyofnervestumpsandsystem-
atizedbis clinical observations undertbenameof 'neuroglioma
syndrome. Nageottecalledtbeswollenstump,wbicbisoftenvery
large, tbe amputationneuroma,madeof axis cylindersand neu-
rogliaformedattbecentralendofaseverednerve. Lericbewas
tbebrsttoseetbattbeneuromaistbestartingpointforare|lex
pbenomenon andbe localized tbe origin of this so-calledre|lex
intbeneuritesspreadtbrougbtbecentralstump.Tbeneuroglioma
syndromeincludesaprivativeaspect,tbeappearance,insbort,of
anunprecedenteddisturbance.Assumingtbattbesympatbetichbers
aretbeordinarypatbofexcitationoriginatingattbeleveloftbe
neuroglioma, Lericbe tbinks tbat tbese excitations
determineunusualvasomotorrellexesattbewrongtime,wbicb
arealmostalwaysvasoconstrictive,andtbesearetberedexes
wbicb,byproducingbypermyotoniaofsmootbhber,determine
atrulynewdiseaseattbeperipbery,juxtaposedtotbesensory
motordehciencyrelatedtoseveringtbenerve. Tbisnewdis-
easeiscbaracterizedbycyanosis, cbill,edema,tropbicdistur-
bances, pain, etc. [74, / 53].
Lericbe'stberapeuticconclusionistbatneurogliomaformationmust
beprevented,particularlybymeansofanervegraft.Tbegraftdoes
notperbapsreestablisbanatomicalcontinuitybutitdoesinsome
waysettbeextremityoftbecentralendanditcbannelstbeneu-
rites bypusbingtbemtotbeupperend. A tecbniquedeveloped
by!oerstercanalsobeusedwbicbconsistsinbindingtbeneuro-
lemmaandmummifyingtbestumpwitbaninjectionofabsolute
alcobol.
A.C. Weiss, working along tbe same lines as Lericbe, tbinks
stillmore clearly tban tbe latter tbat, witb regard to disease of
tbe neuroglioma, itis appropriateand sufhcient to suppress tbe
neurogliomarigbtawaywitboutlosingtimein 'miming tbere-
establisbmentofanatomicalcontinuitybymeansofagraftorsu-
ture.Witbtbisprocedureanintegralrestitutionintbeareaoftbe
injurednervecannotbeexpectedwitbanyassurance. butitisa
matterofcboosing. !orexample,intbecaseofelbowseizure, one
mustcboosebetweenwaitingforpossible improvementoftbepa-
ralysis ifrestorationofnervouscontinuityiseffectedfollowinga
DISEASE, CURE, HEALTH
graft,orimmediatel procuringfortbepatienttbeuseofoneband
wbicb will always bepartiallyparalyzed but wbicb will becapa-
ble of verysatisfyingfunctional agility.
klein'sbistologicalstudiescanperbapsexplainalltbesepbe-
nomena[ 1 1 9]. Wbatevertbemodalitiesofdetailobservedaccord-
ingtotbecases(sclerosis,|n|lammation,bemorrbage,etc. ), every
bistological examination of neuromata sbows one constantfact,
namelytbepersistentcontactestablisbedbetweentbeaxiscylin-
ders'neuroplasmand tbeproliferation, sometimes considerable,
of neurolemmata. Tbisverihcationautborizesacloserelationsbip
betweentbeneuromataandtbe receptorendings of tbegeneral
sensibility, constitutedbytbe endingof tbe neuritesproperand
bytbeelementsdifferentiatedbutalwaysderivingfromtbeneu-
rolemmata.TbiscloserelationsbipwouldconhrmLericbe'sccn-
ceptionstbattbeneurogliomaisindeedastartingpointforunusual
excitations.
betbatasitmay,A. C. Weissand ]. Warterarej ustihedinas-
serting.
Toanuncommondegreetbediseaseoftbeneurogliomagoes
beyondtbeframeworkoftbesimple,sensitivemotorinterrup-
tionandveryoften, because of its seriousness, itconstitutes
tbeessenceof tbeinhrmity. Tbisissotruetbatifonesome-
bowsucceedsinfreeingtbepatientfromdisturbanceslinked
totbeexistenceoftbeneuroglioma,tbesensorymotorparal-
ysiswbicbpersistsassumesatrulysecondaryaspect,oftencom-
patiblewitbalmostnormaluseoftbeaffectedmember[ 1 1 8].
Tbeexample of neuroglioma diseaseseemsto us perfectly
suitedto illustratetbeideatbatdiseaseisnotmerelytbedisap-
pearanceofapbysiologicalorderbuttbeappearanceofanewvital
order,anideawbicb isasmucbLericbe's aswesawintbehrst
1
93
partoftbis study asColdstein'sandwbicbcouldcorrectlyjus-
tifytbebergsoniantbeoryofdisorder.Tbereisnodisorder,tbere
istbesubstitutionforanexpectedorlovedorderofanotberorder
wbicb eitber makes no difference orfrom wbicb one suffers.
but Weiss and Warter, inpointing out tbat afunctional restitu-
tion,satisfyingintbeeyesoftbepatientandalsobisdoctor,can
beobtainedwitboutarestitutio ad inteBrum intbetbeoreticallycor-
respondinganatomicalorder, conhrmColdstein'sideasoncure in
a way wbicb is certainlyunexpectedfor tbem. Coldstein says
Tbus,beinB well meanstobecapableoforderedbebaviorwbicb

mayprevailinspiteoftbeimpossibilityofcertainperformances
wbicbwereformerlypossible. buttbe newstateof bealtb is
nottbe same astbe old one. . . . ]ustasadehniteconditionas
tocontentsbelongs to tbeformer stateofnormality, soalso a
dehuite conditionas to contents belongs to tbenew normal-
ity,butofcoursetbecontentsofbotbconditionsdiffer. Tbis
conclusion,wbicbfollowsasamatterofcoursefromourcon-
ceptoftbeorganismwbicbisalsodeterminedastocontents,
becomesoftbegreatestimportancefortbepbysician'sattitude
towards tbose wbobave regained tbeir bealtb. . . . Tobecome
wellagain,inspiteofdefects,alwaysinvolvesacertainlossin
tbe essentialnatureoftbeorganism. Tbiscoincideswitbtbe
reappearanceof order. A new individual norm corresponds to
tbis rebabilitation.
Uowveryimportanttberegainingoforderisforrecuper-
ationcanbeseenfrom tbefacttbattbe organism seems pri-
marilytobavetbetendencytopreserve,orgain,sucbcapacities
wbicbmaketbispossible.Tbeorganismbrstofallappearsset
ongainingconstantsanew. Wemayhndinrecovery(witbre-
1
94
sidual defect)cbangesinvarious helds ascomparedtotbefor-
mer natureof tbe organism,but tbe bebaviorsbowstbattbe
cbaracteroftbeperformancesisagain'constant. Wehndcon-
stantsintbebodilyaswellasintbementalb eld.!orinstance,
ascomparedtotbeformerbebavior,web ndacbangeinapulse
rate,bloodpressure,sugarcontentoftbeblood,intbresbolds,
mentalperformances,etc.,buttbismodihcationisoneofnewl
formedconstantsintberespectivehelds.Tbesenewconstants
guaranteetbeneworder.Wecanunderstandtbebebaviorof
tberecuperatedorganismonlyfweconsidertbisfact.We must
notattempttointerferewitbtbesenewconstants, becausewe
would tbus createnewdisorders. Webavelearnedtbat fever
isnotalwaystobecombated,buttbatanincreaseintempera-
turemaybeunderstoodas oneof tbose constants wbicbare
necessarytobringabouttberecovery. Webavelearnedtotreat
quitesimilarlycertainformsofincreasedbloodpressureorcer-
tainpsycbologicalcbanges.Tberearemanysucbalterationsof
constantswbicbtodaywestill attempttoremovefortbeiral-
legedbarmfulness, wbereasitwouldbebetternottointerfere
witb tbem +6, Lnglisb edition, pp. +171].
Onewouldgladlyempbasizebere asopposedtoonewayof
citing Coldstein wbicb gives tbe appearance of initiation into a
bermetic orparadoxicalpbysiology tbeobjectivityandevenba-
nalityofbisleadingideas.|tisnotonlytbeobservationsofclini-
cians(wboareunfamiliarwitbbistbeses)butalsoexperimental
verihcationswbicbgoalongtbelinesofbisownresearcb.Lidn't
kayserwrite in l 91z.
Tbearellexiaobservedaftera transversespinalsectionstems
from tbe interruptionof tbe redexarc itself. Tbe disappear-
ance of tbestateofsbockaccompaniedby tbereappearance
1
95
oftbere|lexesisnot,strictlyspeaking,areestablisbmentbut
ratbertbeconstitutionofanew'reducedindividual.Anew
entityiscreated,'tbespinalanimal(vonWeizsaecker)[63 his,
l l ].
|nassertingtbatnewpbysiologicalnormsarenottbeequiva-
lentofnormsexistingbeforetbedisease,Coldstein,ontbewbole,
only conbrms tbe fundamental biological factthat life does not
recognizereversibility. butif life does not admitof reestablisb-
ments,itdoesadmitofrepairswbicbarereallypbysiologicalin-
novations.Tbe more orlesslargereductionof tbese innovation
possibilitiesisameasureoftbeseriousnessoftbedisease.Asfar
as bealtb in tbe absolute sense is concerned, it is notbing otber
tbantbeinitialboundesscapacitytoinstitutenewbiologicalnorms.
Tbe frontispiece of \ol . \| of tbe Encclopedie jranraise, 'Tbe
Uumanbeing,publisbedunderLericbe'sdirection,sbowsbealtb
intbe guise of an atblete tbrowing weigbts. Tbis simpleimage
seems to us to beas fullyinstructive as all tbe pages following,
wbicbaredevotedtodescribingtbenormalman.Wenowwant
togatbertogetberallourre|lectionsscatteredtbrougboutearlier
explanationsandcriticalexaminationsinordertooutlineadehni-
tionof bealtb.
|fweacknowledgetbefacttbatdiseaseremainsakindofbi-
ological norm, tbismeanstbattbepatbologicalstatecannot be
calledabnormalinanabsolutesense,butabnormalinrelationto
a well-dehnedsituation. |nversely, being bealtbyand being nor-
malarenotaltogetberequivalentsincetbepatbologicalisonekind
ofnormal.beingbealtbymeansbeingnotonlynormalinagiven
situationbutalsonormativeintbisandotbereventualsituations.
Wbat cbaracterizes bealtb is tbe possibilityof transcending tbe
norm,wbicbdebnestbemomentarynormal,tbepossibilityoftol-
eratinginfractionsoftbebabitualnormandinstitutingnewnorms
innewsituations. lnanenvironmentandsystemofgivenrequire-
ments,oneremainsnormalwitbonekidney. butonecannolonger
allowoneselftbe luxuryoflosingakidney,onemusttakecareof
itandoneself. Commonsensemedicalprescriptionsaresofamil-
iartbatwedon't lookfor deepmeaningin tbem. And yet bow
distressinganddifhcultitistoobeytbedoctorwbosays.Takecare
ofyourself' '|tisvery easy tosaytakecareof myself but | bave
my bouseboldtorun, saidtbemotberof afamilyinabospital
consultation,wbo,insayingit,badnointentionofbeingironic,
no ideaof semantics.
Abouseboldistbecontingencyofasick
busbandorcbild,atornpairofpantswbicbmustbemendedin
tbeeveningwbentbecbildisinbedsincebebasonlyonepairof
pants,tbelongtriptotbebakeryforbreadiftbeusualoneisclosed
forbreaking tbe law, etc. Uow difb cultitistotake careofone-
selfwbenonelivedwitboutknowingatwbattimeoneate,wbetber
tbe stairsweresteepornot,tbe bouroftbelasttramsince,ifit
were past,onewouldgobomeon foot,evenalongway.
Uealtb is a margin of tolerance for tbe inconstancies of tbe
environment. but isn't itabsurd to speak of tbe inconstancy of
tbeenvironment?Tbis istrueenougbof tbebuman social envi-
ronmentwbereinstitutionsarefundamentallyprecarious,conven-
tionsrevocable,andfasbionsaslleetingasligbtning. butisn'ttbe
cosmicenvironment,tbeanimalenvironmentingeneralasystem
of mecbanical, pbysical andcbemical constants, madeof invari-
ants?Certainlytbis environment,wbicbscience dehnes, ismade
oflawsbuttbeselawsaretbeoreticalabstractions.Tbelivingcrea-
ture does not live amonglaws butamong creatures andevents
wbicbvarytbeselaws. Wbatboldsuptbebirdistbebrancband
nottbelawsofelasticity. |fwereducetbebrancbtotbelawsof
elasticity,wemustnolongerspeakofabird,butofcolloidalso-
1
97
lutions. Atsucbalevel ofanalyticalabstraction,itisnolongera
questionof environmentforalivingbeing,norof bealtb nor of
disease. >imilarly, wbat tbefox eats istbeben'segg andnot tbe
cbemistryofalbuminoidsortbelawsofembryology. becausetbe
qualihedlivingbeinglivesinaworldofqualihedobjects,belives
inaworldofpossible accidents. Notbingbappensbycbance,ev-
erytbingbappensintbeformofevents.Uereisbowtbeenviron-
ment is inconstant. |ts inconstancy is simply its becoming, its
bistory.
!ortbelivingbeinglife is notamonotonousdeduction,arec-
tilinearmovement,itignoresgeometricalrigidity, itisdiscussion
orexplanation(wbatColdsteincallsAuseinandersetzun
a) witban
environmentwberetbereareleaks, boles, escapesandunexpected
resistances. Letus sayitoncemore. Wedonotprofessindeter-
minism, a position verywell supported today. Wemaintaintbat
tbelifeoftbelivingbeing,wereittbatofanamoeba,recognizes
tbe categories of bealtbanddiseaseon|yon tbelevel of experi-
ence,wbicbisprimarilyatestintbeaffectivesenseoftbeword,
andnotontbelevel ofscience. >cienceexplains experience but
itdoes notforall tbat annul it.
Uealtbisasetofsecuritiesandassurances(wbattbeCermans
callSicherunaen) , securities intbe present, assurancesfortbefu-
ture.Astbereisapsycbologicalassurancewbicbisnotpresump-
tion,tbereisabiologicalassurancewbicbisnotexcess,andwbicb
is bealtb. Uealtb is a regulatory|lywbeelof tbe possibilities of
reaction.Lifeisusuallyjusttbissideofitspossibilities,butwben
necessaryitsbowsitselfaboveitsanticipatedcapacity.Tbisisclear
inin|lammationdefensereactions.|ftbehgbtagainstinfectionwere
instantaneouslyvictorious,tberewouldbenoin|lammation. |f or-
ganic defenses were immediately forced, tbere wouldno longer
be in|lammation. |f in|lammation exists itisbecause tbe anti-
infectiousdefenseisatoncesurprisedandmobilized.Tobeingood
DISEASE, CURE, HEALTH
bealtb means being able tofallsickand recover, itisabiological
luxury.
|nversely,diseaseis cbaracterizedbytbefacttbatit is areduc-
tionintbemarginoftolerancefortbeenvironment'sinconstancies.
|n speaking of reduction we do not mean to fall subject to tbe
criticismwegaveoftbeconceptionsofComteandbernard.Tbis
reduction consists in beingable to live onlyinanotberenviron-
mentandnotmerely in someparts of tbeprevious one. Tbis is
wbatColdsteinsawveryclearly. Atbottom,popularanxietyintbe
faceoftbecomplicationsofdiseaseexpressesnotbingbuttbisex-
perience.We aremoreconcernedabouttbediseaseanygivendis-
easemayplungeusintotbanaboutdiseaseitself,for itismorea
matterof one diseaseprecipitating anotber tbana complication
ofdisease.Lacbdiseasereducestbeabilitytofaceotbers,usesup
tbeinitialbiologicalassurancewitboutwbicbtberewouldnoteven
belife. Veaslesis notbing, but it's broncbial pneumonia tbatwe
dread. >ypbilis is sofeared only after itstrikes tbe nervous sys-
tem. Liabetesisnotsoseriousifitisjustglycosuria.butcoma?
gangrene?wbatwill bappen if surgery is necessary?Uemopbilia
isreallynotbingaslongasatraumatismdoesnotoccur.butwbo
isn'tintbesbadowofatraumatism, barringareturntointrauter-
ine existence? |f even tben'
|bilosopbersargueastowbetbertbelivingbeing'sfundamen-
taltendencyisto conserveorexpand. Vedical experiencewould
indeed seem to bring to bearan importantargumentintbe de-
bate. Coldsteinnotestbattbemorbidconcerntoavoidsituations
wbicbmigbteventuallygeneratecatastropbicreactionsexpresses
tbeconservationinstinct.Accordingtobim,tbisinstinctisnottbe
generallawof life buttbe lawof awitbdrawnlife.Tbe bealtby
organismtrieslesstomaintain itselfinitspresentstateandenvi-
ronmenttban torealize its nature.Tbisrequirestbattbeorgan-
ism,infacingrisks,acceptstbeeventualityofcatastropbicreactions.
1 99
Tbebealtbymandoesnotlleebeforetbeproblemsposedbysome-
timessuddendisruptionsofbisbabits,evenpbysiologicallyspeak-
ing,bemeasuresbisbealtbintermsofbiscapacitytoovercome
organic crises in order to establisb a new order[49].
Vanfeels ingoodbealtb wbicbisbealtbitself onlywben
befeelsmoretbannormal tbat is, adaptedtotbeenvironment
anditsdemands butnormative,capableoffollowingnewnorms
of life. |t is obviously not witb tbe express intention of giving
mentbisfeelingtbatnaturebuilttbeirorganismswitbsucbprodi-
gality.toomanykidneys,toomanylungs,toomucbparatbyroid,
toomucb pancreas, even too mucb brain, if buman life were
limitedtotbevegetativelife. '
>ucbawayoftbinkingexpresses
tbe most naive fatalism. but it bas always been so. man feels
supportedbyasuperabundanceofmeanswbicbitisnormalfor
bim toabuse. As opposedtosomedoctors wbo are tooquick to
see crimes in diseases because tbose affected committed some
excess or omission somewbere, we tbink tbat tbe power and
temptation to fall sick are an essential cbaracteristicof buman
pbysiology. Toparapbrase a saying of \alry, we bave said tbat
tbe possible abuseof bealtbis part of bealtb.
|nordertoevaluate tbenormal andtbepatbological,buman
lifemustnotbelimitedtovegetativelife. |fneedbe, aman can
livewitbmanymalformationsorailmentsbutbecanmakenotb-
ingof bislife, or, at least, be can always makesometbingof it
anditisintbissensetbatifitrepresentsadaptationtoimposed
circumstances,everystate of tbeorganism, insofarasitiscom-
patiblewitblife,endsupbeingbasicallynormal.buttbisnormal-
ityispayedforbyrenouncingalleventualnormativity.Van,even
pbysicalman,isnotlimitedtobisorganism.Uavingextendedbis
organsbymeansoftools,manseesinbisbodyonlytbemeansto
allpossiblemeansofaction.Tbus,inordertodiscemwbatisnor-
malorpatbologicalfortbebodyitself,onemust lookbeyondtbe
200
DI SEASE. CURE . HEALTH
body. Witbadisabilitylike astigmatismormyopia,onewouldbe
normal inan agricultural ora pastoral society but abnormal for
sailingor|lying. !romtbemomentmankindtecbnicallyenlarged
itsmeans of locomotion, tofeel abnormal is to realize tbatcer-
tainactivities,wbicbbave become a needandan ideal, areinac-
cessible. Uencewecannotclearlyunderstandbowtbesameman
witbtbesameorgansfeelsnormalorabnormalatdifferenttimes
inenvironmentssuitedtomanunlessweunderstandboworganic
vitalitydourisbes inman intbe form of tecbnicalplasticityand
tbe desire to dominate tbe environment.
|fwenowmovebackfromtbeseanalysestotbeconcretefeel-
ingoftbestatetbeyaretryingtodehne,wewillunderstandtbat
formanbealtbisafeelingofassuranceinlifetowbicbnolimitis
hxed. Valere, fromwbicbvaluederives,meanstobeingoodbealtb
in Latin. Uealtb is a way of tackling existence as one feels tbat
oneisnotonlypossessororbearerbutalso, ifnecessary, creator
ofvalue,establisberofvitalnorms. Uencetbisseductionstillex-
ertedonourmindstodaybytbeimageoftbeatblete,aseduction
ofwbicbcontemporaryinfatuationfororganizedsportseems to
us to be merely a sadcaricature.
20 1
CHAPTER V
Ph
y
s iolo
gy
and Patholo
gy
Asaconsequenceoftbeprecedinganalyses,i tseemstbatadeb ni-
tionofpbysiologyastbescienceoftbelawsorconstantsofnor-
mallifewouldnotbestrictlyexactfortworeasons.hrst,because
tbeconceptofnormalisnotaconceptofexistence,initselfsus-
ceptibleofobjectivemeasurement,andsecond,becausetbepatbo-
logicalmustbeunderstoodasonetypeofnormal,astbeabnormal
is not wbatis not normal, but wbat constitutesanotbernormal.
Tbis does notmean tbatpbysiology is nota science. |tisgenu-
inelysointermsofitssearcbforconstantsandinvariants,itsmet-
ricalprocedures,anditsgeneralanalyticalapproacb.butitiseasy
tospecifyhow pbysiologyisascienceintermsofits
metbod,less
easytospecifyof what, intermsofitsobject.>ballwecallittbe
scienceoftbeconditionsofbealtb?|nouropiniontbiswouldal-
readybepreferabletotbescienceoftbenormalfunctionsoflife
sincewe bave believedwe must distinguisbbetweentbenormal
stateandbealtb.butonedifhcultypersists. Wbenwetbinkoftbe
objectofa sciencewetbinkofastableobjectidenticalto itself
|ntbisrespect,matterandmotion,governedbyinertia,fulhllevery
requirement.butlife?|sn'titevolution,variationofforms,inven-
tionofbebaviors?|sn'titsstructurebistoricalaswellasbistolog-
ical?|bysiologywouldtbentendtowardbistory,wbicbisnot,no
20
3
matterwbatyoudo, tbescienceofnature. |t istruetbatweare
nonetbelessstruckbylife'sstablequaliq|nsbort,inordertodebne
pbysiology,everytbingdependsonone'sconceptofbealtb.Rapbael
Lubois, wbo is, to our knowledge, tbe only nineteentb-century
autborofaworkonpbysiologyinwbicbanotmerelyetymologi-
cal orpurelytautological debnition ofitisproposed,derives its
meaningfrom tbe Uippocratic tbeoryofnatura medicatrix:
Tberoleofnatura medicatrix isidentihedwitbtbatoftbenor-
malfunctionsof tbe organism wbicb areallmoreor less di-
rectly conservative or defensive. |bysiologyistbe study of
notbingotbertbantbefunctionsoflivingbeings,orinotber
words,tbenormalpbenomenaoftbelivingproteonorbiopro-
teon[ 35, 1 0] .
Nowi fwe agree witb Coldsteintbattberei sonlya really con-
servativetendencyindisease, tbattbebealtbyorganismiscbar-
acterizedbytbetendencytofacenewsituationsandinstitutenew
norms, we cannotbe satished witb sucb a view.
>igerist, wbo tries to dehnepbysiologybyunderstandingtbe
signihcanceoftbehrstdiscoverywbicbgaverisetoit Uarvey's
discoveryoftbecirculationoftbeblood(1 628) - proceedsinbis
usualfasbion,wbicbistoplacetbisdiscoverywitbintbeintellec-
tual bistory of civilization. Wby dida functional conception of
lifeappeartben,notsooner,notlater?>igeristdoesnotseparate
tbescienceoflife,bornin1 628, fromtbegeneral,letussay,pbil-
osopbicalconceptionoflifewbicbwastbenexpressedintbein-
dividual'svariousattitudestowardtbeworld.!romtbeendoftbe
sixteentbandtbebeginningoftbeseventeentbcenturytbeplastic
artshrstestablisbedtbebaroquestyleandliberatedmovementevery-
wbere. Tbebaroqueartist,asopposedtotbeclassicalartist,seesin
natureonlywbatisuncompleted,potential,notyetcircumscribed.
PHYSIOLOGY AND PATHOLOGY
baroque manisnotinterestedinwbat is, but wbatisontbe
waytobeing.Tbebaroqueis inhnitelymoretbanastyleinart,
it is tbe expression of a form of tbougbtwbicb at tbis time
governsallareas of tbebuman spirit. literature, music, fasb-
ion, tbe >tate, tbe mode of living, tbe sciences[1 07, 4/ ].
|n establisbing anatomy at tbe beginning of tbe sixteentbcen-
turymenfavoredtbelivingform'sstatic,delimitedaspect.Wbat
Wlhlin says of tbe baroque artist, tbatbe sees not tbeeye but
tbegaze,>igeristsaysoftbepbysicianattbebeginningoftbesev-
enteentb century.
Uedoesnotseetbemusclebutitscontractionandtbeeffect
itproduces.Tbisisbowanatomia animata, pbysiology, isborn.
Tbeobjectoftbisscienceismovement.|topenstbedoorsto
tbeunlimited. Lacbpbysiologicalproblemleadstotbesources
of life and permits an escape to inhnity [ibid].
Uarvey, tbougbananatomist, sawnotformbutmovementintbe
body. Uis researcbisnotbasedontbe conhgurationoftbebeart
butonobservingtbepulseandrespiration,twomovementstbat
ceaseonlywitblife.Tbefunctionalideainmedicineisconnected
witbVicbelangelo'sartandCalileo'sdynamicmecbanics[107, 42].
|tseemstous,followingearlierconsiderationsonbealtb,tbat
itgoeswitboutsayingtbattbis'spiritofnascentpbysiologymust
bekeptintbe dehnitionofpbysiologyastbescienceoftbecon-
ditionsofbealtb.Webavespokenonseveraloccasionsoftbemodes
oflife, preferringtbisexpressionincertaincasestotbetermbe-
baviorinorderto empbasizebettertbefacttbatliIe isdynamic
polarity. |tseemstoustbatindehningpbysiologyastbescience of
the stabilized modes of li, wearemeetingalmostalltbedemands
stemmingfromourprevious positions. Ontbeonebandwe are
assigningtoresearcbanobjectwboseidentitytoitselfistbatof
babitratbertbannature,butwboserelativeconstancyisperbaps
moreexactlyadequatetotakeintoaccounttbenonetbelesslluc-
tuatingpbenomenawitbwbicbtbepbysiologistisconcerned.On
tbeotberband,wereservetbepossibilityforlifetogobeyondtbe
codihedbiologicalconstantsorinvariantsconventionallybeldas
normsataspecihcmomentofpbysiologicalknowledge.|neffect,
modes can be establisbedonlyafterbavingbeenputto tbe test
bydisruptinganearlierstability. !inally,itseemstoustbatstart-
ingfromtbedehnitionproposed,weareabletodelimitcorrectly
tbe relations between pbysiology andpatbology.
Tbereare two kindsoforiginalmodesoflife.Tbereare tbose
wbicbarestabilizedinnewconstantsbutwbosestabilitywillnot
keeptbemnombeingeventuallytranscendedagain.Tbesearenor-
malconstantswitbpropulsivevalue.Tbeyaretrulynormalbyvir-
tueoftbeirnormativiqAndtberearetbosewbicbwillbestabilized
intbeform of constants, wbicb tbe living being'severyanxious
effortwilltendtopreservefromeveryeventualdisturbance.Tbese
arestillnormalconstantsbutwitbrepulsivevalueexpressingtbe
deatbofnormativityintbem.|ntbistbeyarepatbological,altbougb
tbey arenormalas long as tbe livingbeingisalive. |n sbort, tbe
momentpbysiologicalstabilityisrupturedinaperiodofevolving
crisis, pbysiology loses its rigbts butitdoes notfor all tbatlose
tbetbread.|tdoesnotknowinadvancewbetbertbenewbiolog-
icalorderwillbepbysiologicalornot,butlateronitwillbavetbe
meanstohndoncemoreamongtbeconstantstbosewbicbitclaims
foritsown.Tbiswillbetbecase,forexample,iftbeenvironment
ismadetovaryexperimentallyinordertolearnwbetbertbecon-
stantswbicbaremaintainedcanaccommodatetbemselvesornot
witboutcatastropbetoalluctuationintbeconditionsofexistence.
Tbis is, for example, tbe leading tbread wbicb allows us to un-
derstandtbedifferencebetweenimmunityand anapbylaxis. Tbe
206
PHYSI OLOGY AND PATHOLOGY
presenceofantibodiesintbeblood iscommon to botbformsof
reactivity. butwbile immunity makes tbeorganism insensibleto
anintrusionofmicrobesortoxinsintbeinnerenvironment,ana-
pbylaxis is an acquired supersensitivity to tbe penetration of
specib c,particularlyprotein, substances into tbe innerenviron-
ment[1 04]. After a hrstmodihcation (by infection, injectionor
intoxication)of tbe innerenvironment,a secondbreak-in is ig-
noredby tbeimmunized organism, wbile intbe case ofanapby-
laxis, itprovokesa sbock reactionofextremegravity, veryoften
fatal, so sudden tbatitbas qualihed tbeexperimentalinjection
wbicbprovokesitwitbtbetermunleashing [dechafnante], bencea
typicallycatastropbic reaction.Tbepresenceofantibodiesinblood
serumistbusalwaysnormal,tbeorganismbavingreactedbymodi-
[ingitsconstantstoahrstaggressionoftbeenvironmentandbeing
regulatedbyit, but inonecasetbenormalityispbysiologica|, in
tbe otber, patbological.
Accordingto>igerist,\ircbowdehnedpatbologyasa'pbysiology
witbobstacles[ 107, 1 37]. Tbiswayofunderstandingdiseaseby
derivingitfromnormalfunctions,tbwartedbyaforeignaddition
wbicbcomplicatestbemwitboutalteringtbem,comesclosetotbe
ideas of Claude bernard and proceeds from very simple patbo-
genicprinciples.Weknow,forexample,bowabeartorkidneyis
made,bowbloodorurinepassestbrougbtbem,ifweimaginetbe
ulceratinggrowtbsofendocarditisontbemitralvalveorastone
intberenalpelvis,weareinapositiontounderstandtbepatbogeny
ofsymptomssucbasbeartmurmurorpainradiatingfromnepbretic
colic. butperbapstbereisconfusionintbisconception,ofaped-
agogicalandbeuristickind.Vedicalteacbingrigbtlybeginswitb
tbeanatomyandpbysiologyoftbenormalman,startingnomwbicb
tbe reasonforcertainpatbologicalstatescansometimesbeeasily
20
7
deducedbyacknowledgingcertainmecbanical analogies, forex-
ample, intbecirculatorysystem.cardiacliver,dropsy,edemas,in
tbesensorymotorsystem.bemianopsiaorparaplegia. |tseemstbat
tbeorderofacquiringtbeseanatomicandpbysiologicalcorrespon-
dencesbas been inverted. !irst ofall,itistbesickmanwboone
dayascertainedtbat 'sometbingwaswrong, benoticedcertain
surprisingorpainfulcbangesinbismorpbologicalstructureorbe-
bavior.Rigbtlyorwronglybecalledtbemtotbeattentionofbis
doctor.Tbelatter,alertedbybispatient,proceededtoametbod-
ical exploration of tbe patent symptoms and even more tbe la-
tentsymptoms. |ftbepatientdied,anautopsywasperformed,all
kindsofmeanswereemployedtolookforcertainpeculiaritiesin
alltbeorgans,wbicbwerecomparedwitbtbeorgansofindivid-
ualdeadmenwbobadneversbownsimilarsymptoms.Tbeclini-
cal observation and tbe autopsyreportwerecompared. Uere is
bowpatbology,tbankstopatbologicalanatomybatalsotbanksto
bypotbesesorknowledgeconcerningfunctionalmecbanisms,bas
become a pbysiologywitb obstacles.
Nowbereisaprofessionaloversigbt perbapscapableofbeing
explainedbytbe!reudiantbeoryoflapsesandfailedacts wbicb
mustbepointedout.Tbepbysicianbasatendencytoforgettbat
itistbepatientswbocallbim.Tbepbysiologistbasatendencyto
forgettbataclinicalandtberapeuticmedicine,wbicbwasnotal-
wayssoabsurdasonemigbttbink,precededpbysiology. Oncetbis
oversigbt is remedied, we are led to tbink tbatitis tbe experi-
enceofanobstacle, hrstlivedbyaconcretemanintbeform of
disease,wbicbbasgivenrisetopatbologyinitstwoaspects,clin-
icalsemiologyandtbepbysiologicalinterpret+tionofsymptoms.
|ftberewerenopatbologicalobstaclestberewouldbenopbysi-
ologybecausetberewouldbenopbysiologicalproblemstosolve.
>ummarizingtbebypotbesesweproposedintbecourseofexam-
ining Lericbe's ideas, we can say tbat inbiologyitis tbepathos
208
wbicb conditions tbe10805 because itgives it its name. |t is tbe
abnormalwbicbarousestbeoreticalinterestintbenormal.Norms
arerecognizedassucbonlywbentbeyarebroken. !unctionsare
revealedonlywbentbeyfail. Life risestotbeconsciousnessand
scienceof itselfonlytbrougbmaladaptation,failureandpain. A.
>cbwartz,followingLrnestNaville,pointsouttbeglaringdispro-
portion between tbe place occupied by sleep in men's lives and
tbeplaceaccordeditinworksofpbysiologyl0], justasCeorges
Lumaspointsouttbattbebibliograpbyonpleasureisminutecom-
pared to tbe pletbora of works devoted topain. Tbis is because
tbeessenceof sleepandenjoymentistoletlifegowitboutcall-
ingitto account.
|ntbe Traite de phJsiol08ie normale et pathol08ique Treatiseon
Normaland|atbological|bysiology]l],Abelouscreditsbrown-
>quardwitbbavingfoundedendocrinologybydetermininginl 6
tbatcuttingouttbeadrenalglands brougbtabouttbedeatbofan
animal. |t seems tbattbisisafactwbicbissufhcientinitself Tbe
questionisnotaskedastobowitoccurredtobrown->quardto
carryouttberemovaloftbeadrenalglands. |ntbeignoranceof
tbeadrenalglands'functions,tbisisnotadecisiontbatonereacbes
bydeduction. No, but itistbe re|lection of anaccident. Andin
fact>igeristsbowstbatitisclinical practicewbicbstimulateden-
docrinology. |n l Addison describedtbe disease wbicb since
tben bas carried bisnameandwbicbbe attributed to an attack
ontbeadrenalglandsl07,/].>tartingnomtbis,brown->quard's
experimentalresearcbisunderstood. |ntbesameTraite de phJsiol08ie
l l z, i0i i ],Tournadejudiciouslypointsouttberelationbetween
brown->quardandAddisonandrelatestbisanecdoteofgreatepis-
temological signihcance. in l 7l 6tbe bordeaux Academy of >ci-
encesproposedas tbesubjectof a competition. 'Wbataretbe
adrenalglands usedfor?Vontesquieu,wbowasresponsiblefor
tbe report, concluded tbat nopapersubmitted could satisfy tbe
Academy'scuriosityandadded.'Onedayperbaps cbancewillac-
complisbeverytbingtbatall tbeeffortintbeworldcouldnot.
To takeanotberexamplefromtbesamekindofresearcb,all
pbysiologiststracetbe 1 889 discoveryof tberoleof tbepancre-
aticbormoneinglucidemetabolismtovonVeringandVinkowski.
but it is often not known tbat if tbese two researcbersmade a
dogdiabetic,asfamousinpatbologyas>aintRocb'sinbagiogra-
pby,itwas quite unintentional. |t was in studying external pan-
creatic secretionandits role in digestiontbat tbe dog bad its
pancreasremoved. Naunyn,inwbosedepartmenttbeexperiment
took place, says tbat itwas summerandtbelabboywas struck
bytbeunusualnumberof|liesaroundtbeanimalcages.Naunyn,
actngontbeprincipletbatwberetbereissugar,tbereare |lies,
recommendedtbattbedog'surinebeanalyzed.\onVeringand
Vinkowski, tben,bymeansoftbepancreatectomy, badbrougbt
intobeinga pbenomenonanalogoustodiabetes[2]. Tbusartihce
makesclarihcation possible, butwitboutpremeditation.
Likewise we sbould tbink a moment about tbese words of
Ljerine.
|tisalmostimpossibletodescribepreciselytbesymptomsof
paralysisoftbeglossopbaryngealnerve.ineffectpbysiologybas
notyetestablisbedexactlytbemotordistributionoftbisnerve
andontbeotberbandisolatedparalysisoftbeglossopbaryn-
gealnerveisneverobserved,sotospeak, inclinicalpractice.
|nrealitytbeglossopbaryngealnerveisalwaysinjuredwitbtbe
pneumogastricnerveortbe spinalnerve, etc. [ 31 , 58 7].
| tseemstoustbattbehrstifnottbeonlyreasonwbypbysiology
basnotyetestablisbedtbeexactmotordistributionoftbeglos-
sopbaryngealnerveispreciselybecausetbisnervegivesrisetono
isolatedpatbologicalsyndrome.Wben|. Ceoffroy>aint-Uilaireat-
2 1 0
tributedtbegapcorrespondingtobeterotaxiesintbeteratologi-
cal science ofbistimetotbe absence ofeverymorpbologicalor
functionalsymptom, begave evidenceofveryrare perspicacity.
\ircbow'sconceptionof tberelationsbipbetweenpbysiology
andpatbologyisinadequatenotonlybecauseitignorestbenor-
malorderoflogicalsubordinationbetweenpbysiologyandpatbol-
ogy, butalsobecauseitimplies tbatdiseasecreatesnotbingofits
ownaccord.Webavedealttooexplicitlyontbislastpointtocome
backtoitagain. but tbetwoerrors seem toustobeconnected.
|tisbecausediseaseisallowednobiologicalnormofitsowntbat
notbingisexpectedfromitfortbe science of tbenormsoflife.
An obstacle would only slow down or stop ordivert a force or
currentwitboutalteringtbem.Oncetbeobstacleisremoved,tbe
patbologicalwouldagainbecomepbysiological,tbeearlierpbysi-
ological.Nowtbisiswbatwecannotadmit,followingeitberLericbe
orColdstein.Tbenewnormisnottbeold norm. Andastbis ca-
pacitytoestablisbnewconstantswitbtbevalueofnormbasseemed
toustobecbaracteristicoftbeliving being's pbysiologicalaspect,
wecannotadmittbatpbysiologycanbeconstitutedbeforeandin-
dependentlyof patbology inorderto establisbit objectively.
Today itisnottbougbtpossible to publisbatreatise on nor-
malpbysiologywitboutacbapterdevotedtoimmunity,toallergy.
knowledgeof tbelatterpbenomenonrevealsto us tbatabout97%
ofwbitemensbowapositiveskin-testtotuberculin,witboutall
of tbem, bowever, being tubercular. Andyet tbis istbefamous
mistakeofkocb,wboistbesourceoftbisknowledge.Uavingas-
certainedtbattbetuberculininjectioninanalreadytubercularsub-
jectgivesrisetoseriousaccidents,wbileitisbarmlessforabealtby
subj ect,kocbbelievedtbat intuberculinizationbebadfoundan
infalliblediagnostictool.butbaving alsowronglyattributedtoit
a curative value, beobtainedresultswbose sad memory was ef-
facedonlybytbeirsubsequentconversionintoaprecisediagnos-
2 I I
tic i nstrument and preventive detection, namely tbe skin-test
ascribedtovon |irquet. Almosteverytimetbatsomeonesaysin
bumanpbysiology. 'Todayweknowtbat. . . onewouldhndby
lookingbard andwitboutwisbingtodiminisbtberoleofexper-
imentation tbat tbe problem was posed and its solution often
outlinedbyclinicalpracticeandtberapeuticsandveryfrequently
attbeexpense,biologicallyspeaking,oftbepatient.Tbus,ifkocb
discoveredin1 891 tbepbenomenonwbicbbearsbisnameandnom
wbicbarosetbetbeoryofallergyandtbeskin-testtecbnique,Var-
fan,as early as 1 886, relying ontbe rarity of tbe coexistenceof
tubercular bone localizations, sucb as coxalgia or |ott's disease,
andpbtbisis,badtbeintuition,clinicallyspeaking,tbatcertaintu-
bercularmanifestationscoulddetermineanimmunityforotbers.
|nsbort, intbecaseof allergy, ageneralpbenomenonofwbicb
anapbylaxisisonetype,we discerntbetransitionfrom anigno-
rantpbysiologytoaknowingpbysiologybymeansofclinicalprac-
ticeandtberapeutics.Todayanobjectivepatbologyproceedsfrom
pbysiologybutyesterdaypbysiologyproceededfrom apatbology
wbicbmustbecalledsubjectiveandtberebycertainlyimprudent,
butcertainlybold,andtberebyprogressive.Allpatbologyissub-
jective witbregardto tomorrow.
|s itonly witb regardto tomorrow tbat patbology issubjective?
|ntbissenseallscience,wbicbisobjectiveintermsofitsmetbod
andobject,issubjectivewitbregardtotomorrowsince,sbortof
assumingittobecompleted,manyof today'strutbswillbecome
yesterday'smistakes.Wbenbenardand\ircbow,eacbonbisown,
aimedatestablisbinganobjectivepatbology,tbeoneintbeform
ofapatbologyoffunctionalregulations,tbeotberintbeformof
cellularpatbology, tbeytendedtoincorporatepatbologyintotbe
sciences of nature, to founditon tbe basesof lawand deter-
2 1 2
minism. |tistbisclaimtbatwewanttosubjecttoexamination.
|fitbasnotseemedpossible tomaintaintbedehnitionofpbysi-
ologyastbescienceoftbenormal,itseemsdifhculttoadmittbat
tberecanbeascienceofdisease,tbattberecanbeapurelyscientihc
patbology.
Tbesequestionsofmedicalmetbodologybavenotstirredup
mucbinterestin!rance,neitberontbepartofpbilosopbersnor
ontbe part of pbysicians. Tomyknowledge|ierre Lelbet's old
article in tbe collectionDe la me thode dans les sciences 1z], bas
badnosuccessors.Ontbeotberband,tbeseproblemsbavebeen
treatedwitbgreatconsistencyandcareabroad,particularlyinCer-
many. We plan to borrow anexposition of tbe conceptions of
RickerandVagdebourgandtbe controversies tbeyprovoked, as
given by Uerxbeimerin bis Krankheitslehre der Gegenwart Con-
temporary|atbology](l 9z7). We aredeliberatelygivingtbisex-
positiontbeform ofasummary, parapbrasedandcutfromquo-
tations from pages 6 to l of Uerxbeimer'sbook ]. `
Rickerexpounded bis ideas successivelyi ntbeEntwui einer
Relationspathologie Outline of a |atbologyof Relations] (l90),
Grundlinien einer Logik der Physiologie als reiner Naturwissenschct
!undamentals of a Logicof |bysiologyas |ure >cience](1 91 2);
Physiologie, Pathologie und Medizin |bysiology, |atbology, and
Vedicine](l9z1),Pathologie als Naturwssenschct - Relationspatholo8ie
|atbologyas>cience |atbologyof Relations](l9z+). Ue delim-
itstbeareasofpbysiology, patbology, biologyandmedicine. Tbe
sciencesofnaturearebasedonmetbodicalobservationandrellec-
tion on tbese observations witb a view toexplaining, tbat is, ar-
ticulatingtbecausalrelationsbetweensensible,pbysicalprocesses
takingplaceinmen'senvironmenttowbicbmentbemselves be-
longaspbysicalbeings.Tbisexcludestbepsycbismoftbeobject
of tbesciencesofnature.Anatomydescribesmorpbologicalob-
jects,itsresultsbavenoexplanatoryvalueintbemselves,butac-
2 1
3
quireittbrougbtbeirconnectionwitbtberesultsofotbermetbods,
tbuscontributingtotbeexplanationofpbenomenawbicbaretbe
object of an independentscience, pbysiology.
Wbilepbysiologyexplorestbe courseoftbeseprocesses,wbicb
ismorefrequent,moreregular,andwbicbistbereforecalled
normal,patbology(wbicbbasbeenartihciallyseparatedfrom
pbysiology)isconcernedwitbtbeirrarerforms,wbicbarecalled
abnormal,itmustlikewisebesubjectedtoscientihcmetbods.
|bysiologyandpatbology,joinedtogetberasonescience,wbicb
couldonlybecalledpbysiology,examinetbepbenomenainpbys-
icalman,witbaviewtowardtbeoretical,scientihcknowledge
(La patholoBie comme science naturelle |atbology as Natural
>cience], p. 321 ) , /].
|bysiology-patbologymustdeterminetbecausalrelationsbetween
pbysical pbenomena, butas no scientihcconceptof life exists
apartfromapurelydiagnosticconcept itbasnotbingtodowitb
aimsorendsandconsequentlywitbvaluesinrelationtolife. All
teleology(certainlynotonlytranscendentbutalsoimmanent)wbicb
startsfromtbeorganism'shnalityorisrelatedtoit,totbepreser-
vationof life,etc. , consequentlyeveryvaluejudgment,does not
belongto tbe natural sciences, still less to pbysiology-patbology
[ibid. ].
Tbisdoesnotexcludetbelegitimacyofvaluejudgmentsorprac-
ticalapplications.buttbeformerarerelegatedtobiologyaspart
of tbe pbilosopby of nature, bence part of pbilosopby, and tbe
latterarerelegatedtomed|cineandbygieneconsideredasapplied,
practical,teleologicalscienceswitbtbetaskofutilizing,accord-
ing to tbeir aims, wbat bas been explained. 'Tbe teleological
tbougbtofmedicinerestsontbejudgmentsofcausalityofpbys-
iologyandpatbologywbicbformtbescientihcbasisof medicine
2 1
4
[ 55, 8]. |atbology,aspurescienceofnature,mustprovidecausal
knowledge,butnot produce valuej udgments.
Uerxbeimerrespondstotbesepropositionsofgenerallogicby
sayinghrsttbatitisnotcustomarytoclassbiologywitbinpbilos-
opbyas Rickerdoes, becauseifonereliesontbeexpositionsof
representativesof tbepbilosopbyof values sucbasWindelband,
VtnsterburgandRickert,biologycannotbegrantedtberigbtto
usereallynormativevalues,itmusttbenberankedamongtbenat-
uralsciences.!urtbermore,certainconcepts,liketboseofmove-
ment, nutrition,generation, to wbicb Ricker bimself grants a
teleologicalmeaning,areinseparablefrompatbology, botbforpsy-
cbological reasonspeculiarto tbesubjectconcerned witb it and
forreasonsresidingintbeobjects tbemselveswitbwbicbitiscon-
cerned [ 55, 8].
|ndeed,ontbeonebandscientibcjudgment,evenwbenrelated
tovalue-freeobjects, remains an axiologicalj udgmentbecauseit
isapsycbologicalact. !romtbepurelylogicalorscientihcpoint
of viewit can be 'advantageous, according to Rickerbimself,
toadoptcertainconventionsorcertainpostulates. Andintbissense
wecanadmitwitbWeigertor|etersahnalityoftbelivingbeing's
organizationorfunctions. !romtbispointofview, notions sucb
as tbose of activity, adaptation, regulation and self-preserva-
tion notionswbicbRickerwouldeliminatefrom science are
advantageouslymaintainedinpbysiologyandtbusinpatbologyas
well[ 55, 9]. |n sbort,asRickerclearlysaw,scientihctbougbthnds
ineverydaylanguage,tbenonscientihclanguageoftbemasses, a
defectiveinstrument. but asVarcband says, we are nottbereby
obligedto 'suspecta teleological ulteriormotiveineacbsimply
descriptiveterm. Lverydaylanguageisparticularlyinadequatein
tbe sense tbatitstermsoftenbaveanabsolutemeaningwbilein
ourtbougbtwegivetbemonlyarelativemeaning.Tosay,forex-
ample,tbatatumorbasanautonomousexistencedoesnotmean
2 1
5
tbatit is really independentof tbe patbs, materials and modes
ofnutritionoftbeotbertissuesbuttbatcomparedtotbese,itis
relativelyindependent.Lveninpbysicsandcbemistryweuseterms
andexpressionswitbanapparentlyteleologicalsignib cance,bow-
ever, no one tbinks tbat tbey reallycorrespondtopsycbicalacts
, i 0]. Rickeraskstbatbiologicalprocessesorrelationsnotbe
deducedfromqualitiesorcapacities.Tbelattermustbeanalyzed
inpartial processes andtbeirreciprocalreactionsmustbeascer-
tained. butbe bimself admits tbatwberetbis analysisisunsuc-
cessful in tbe case of nerve excitability, for example tbe
notionof aqualityisinevitableandcanserveasa stimulantfor
tbe searcbfortbe correspondingprocess. |n bis mecbanicsof de-
velopment(Ent wicklungsmech anik ) Rouxisobligedtoadmitcertain
qualitiesorpropertiesoftbeegg,tousenotionsofpreformation,
regulation, etc.,andyetRoux'sresearcbrevolvesaroundtbecausal
explanationoftbenormalandabnormalprocessesofdevelopment
, i i i2].
Ontbeotberband,ifonetakestbepointofviewoftbevery
object ofresearcb, onemust verifyawitbdrawaloftbe preten-
sionsofpbysicocbemicalmecbanicsnotonlyinbiologybuteven
inpbysicsandcbemistry. |nanycasepatbologists,wboanswerin
tbeafb rmativetotbequestionastowbetbertbeteleologicalas-
pectofbiologicalpbenomenamustberetained,arenumerous,no-
tablyAscboff, Lubarscb, Zieben, bier, Uering, R.Veyer,beitzke,
b. !iscber,Uueck,Roessle,>cbwarz.Witbregardtoseriousbrain
lesionssucbasintabes progressive emaciation]orgeneralparal-
ysis,Ziebenforexample,askstowbatextentitisamatterofde-
structiveprocessesandtowbatextentitisamatterofdefensive
orrestorativeprocessesconformingtoapurpose,eveniftbeylack
it , i 2i3]. >cbwartz'sessayon'Larecbercbedusenscomme
catgorie delapensemdicaleTbe |nvestigationof Veaning
as a Categoryof Vedical Tbougbt] must alsobementioned. Ue
2 1 6
designatescausalityasacategory intbekantiansense ofpbys-
ics. 'According to pbysics tbeconceptionof tbeworldisdeter-
minedby tbe applicationof causalityas a categoryto a matter
wbicbismeasurable,dispersed,witboutqualityTbelimitsofsucb
an applicationbegin wbere sucb a breakingup intoparts is not
possible,wbereinbiologyobjectsappearwbicbarecbaracterized
by increasinglydistinctuniformity, individualityandtotality.Tbe
competent category bere is tbat of 'meaning [sens]. 'Veaning
is,sotospeak,tbeorgantbrougbwbicbwegraspstructure, tbe
factofbavingform, inourtbougbt,itistberedectionof struc-
tureintbeconsciousnessoftbeobserver.To tbenotionofmean-
ing,>cbwarzadds tbatof purpose,tbougbitbelongstoanotber
orderofvalue.buttbeybaveanalogousfunctionsintbetwoareas
of knowledge and becomingfromwbicbtbey derive common
qualities.
Tbuswegrasptbemeaningofourownorganizationinitsten-
dencyto preserveitselfandonlyanenvironmentalstructure
wbicbcontainsmeaningallowsustoseepurposesinit.Tbus,
tbrougbtbeconsiderationof purposes, tbeabstractcategory
ofmeaningisblledwitbareallife. Considerationofpurposes
(forexample,asa beuristicmetbod)stillremainsalwayspro-
visory, asubstitute,sotospeak,wbilewaitingfortbeobject's
abstractmeaningto become accessible to us.
bywayofsummary, inpatbologyateleologicalwayoflookingat
tbingsisnolongerrejectedinprinciplebytbemajorityofpresent-
day scientists, yetterms witba teleological content bave always
beenusedwitboutpeoplebeingawareofit[55, /5-/ 6]. Ofcourse,
takingbiologicalpurposesintoconsiderationmustnotexemptre-
searcbfromcausalexplanation.|ntbissensetbekantianconcept
ofb nalityisalwaysrelevant.|tisafact,forexample,tbatremov-
2 1
7
ingtbeadrenalglandsbringsabout deatb.Toasserttbattbeadre-
nalcapsuleisnecessaryforlifeisabiologicalvaluejudgmentwbicb
doesnotrelieveonefrominquiringindetailintotbecausestbrougb
wbicbausefulbiologicalresultisobtained.butinsupposingtbat
acompleteexplanationof tbeadrenalglands' functionsispossi-
ble,teleologicaljudgment,wbicbrecognizestbevitalnecessityof
tbeadrenalcapsule,wouldstillretainitsindependentvalue,pre-
ciselyinconsiderationofitspracticalapplication.Analysisandsyn-
tbesismakeawbolewitboutonesubstitutingfortbeotber. We must
be aware _the dif erence between the two conceptions [ SS, 1 7]. |t is
truetbattbeterm'teleologybasremainedtoocbargedwitbim-
plicationsofatranscendentalkindtobegainfullyemployed,'hnal
isalreadybetter,butwbatwouldbebetterstillwouldbe'organ-
ismic, perbaps, usedbyAscboff because itclearlyexpressestbe
factof beingrelated to tbe totality. Tbis mode of expression is
suitedtotbepresenttendencyinpatbologyandelsewberetoput
tbetotalorganismanditsbebavioragainintotbeforefront[55, 1 7].
CertainlyRickerdoesnotabsolutelyproscribesucbconsider-
ationsbutbedoes wanttoeliminatetbemtotallyfrompatbology
as science ofnatureinordertorelegatetbemtotbepbilosopby
ofnaturewbicbbecallsbiology, andasfar astbeirpracticalap-
plicationisconcerned,tomedicine.Nowtbispointofviewposes
preciselytbe questionof wbetberscba distinctionisuseful in
itselfTbisbasbeenalmostunanimouslydenied,and,itseems,witb
reason. Tbus Varcbandwrites.
!oritisindeedtruetbatpatbologyisnotmerelyanaturalsci-
ence as far as tbeobjectof itsresearcbisconcerned, but it
alsobastbetaskofexploitingtberesultofitsresearcbforprac-
tical medicine.
Ueuck,referringtoVarcband,saystbattbiswouldbeimpossible
2 1 8
witbouttbevalorizationandteleologicalinterpretationofprocesses
refused by Ricker. Let's tbink about a surgeon. Wbatwould be
say if a patbologist, after performinga biopsyofatumor,were
toanswerinsendingbimbishndings, tbatwbetberatumorisma-
lignantorbenignisaquestionforpbilosopby, notpatbology?Wbat
wouldbegained intbedivisionoflabor advocatedbyRicker?To
agreaterextentpracticalmedicinewouldnotgettbesolidscientihc
terrainonwbicbitcouldbebased. Uencewecannotgoalongwitb
Uonigmann,wbo,wbileapprovingRicker'sideasforpatbologybut
rejectingtbemfortbepractitioner,alreadydrawstbeconclusion
tbatpbysiology-patbologyandanatomymustbesbiftedfromtbe
!acultyofVedicinetotbe!acultyof >cience. Tberesultwould
betocondemnmedicinetopurespeculationanddeprive physio
logy-pathology c stimulants c the greatest importance. Lubarscbtook
tbe rigbt view of tbings wben be said.
Tbedangers forgeneral patbology and patbological anatomy
lieprimarilyintbefacttbattbeywouldbecometoounilateral
andtoosolitary,closerrelationsbetweentbemandclinicalprac-
ticeasexistedwben patbologybadnotyetbecomeaspecialty,
wouldcertainlybeofgreateradvantagetobotbparties[55, / S].
Tbereisnodoubttbatindehningtbepbysiologicalstateinterms
oftbefrequency,andtbepatbologicalstateintermsoftberarity
of tbe mecbanisms andstructures tbeyoerforconsideration,
Rickercanlegitimatelyconceivetbatbotbmustdependontbesame
beuristicandexplanatorytreatment.Asweneverbelieveditnec-
essaryto admittbevalidityof a statisticalcriterion,we cannot
admit tbat patbology is completely aligned witbpbysiologyand
becomesscience wbileremainingscienceoftbepathological. |nfact,
alltbosewboaccepttbereductionofbealtbyandpatbologicalbi-
ologicalpbenomena to statistical facts are ledmore orless rap-
2 1
9
idlytoacknowledgetbisostulate,impliedintbisreduction,tbat
(according toa dictum of Vainzer quoted byColdstein). 'tbere
is no dilIerence betweenbealtbylife andsicklife +6, 26/].
We bavealreadyseenwbenweexaminedClaudebenard'stbe-
oryinwbatprecisesensesucbapropositioncanbedefended.Tbe
lawsofpbysicsandcbemistrydonotvaryaccordingtobealtbor
disease. buttofailtoadmittbatfroma biological point ofview,
lifedifferentiatesbetween its states means condemningoneselfto
be even unable to distinguisbfoodfrom excrement. Certainlya
livingbeing'sexcrementcanbefoodforanotberliving beingbut
notfor bim. Wbat distinguisbes foodfrom excrementis not a
pbysicocbemical reality but a biological value. Likewise, wbat
distinguisbes tbe pbysiologicalfrom tbe patbological is not a
pbysicocbemicalobjectiverealitybutabiologicalvalue.AsCold-
steinsays,wbenweareledtotbinktbatdiseaseisnotabiologi-
cal category, tbis sbouldalreadymake us question tbe premises
fromwbicbwe started.
Uowisittbinkabletbatdiseaseandbealtbsbouldnotbebio-
logicalconcepts' |fwe disregard, for amoment,tbecompli-
catedconditions inman, tbis statementiscertainlynotvalid
for animals,wberediseasesofrequentlydecideswbetbertbe
individual organism is 'to beornotto be. ]ust tbinkwbat
detrimentalpartdiseaseplaysintbelifeoftbeundomesticated
animal, i. e. , tbeanimalwbicbdoesnotbenehtbytbeprotec-
tiontbrougbman' |ftbescienceoflife issupposedtobein-
capableofcomprebendingtbepbenomenaofdisease,onemust
doubt seriouslytbe appropriatenessof,andtbe trutb in, tbe
intrinsiccategoriesofasciencesoconstrued+6,Lnglisbedi-
tion, p. +10].
Rickerofcourseacknowledgesbiologicalvalues,butinrefus-
2 20
ing to incorporate values into tbe object ofa science, be makes
tbe study of tbese values part of pbilosopby. Ue bas been re-
proacbed justly inourand Uerxbeimer's opinion for tbis in-
clusion of biology in pbilosopby.
Uowtben to resolvetbisdifhculty. if we lookat it from tbe
strictlyobjectivepointofviewtbereisnodifferencebetweenpbysi-
ologyandpatbology,ifwelookforadifferencebetweentbembave
we left scientihcground?
Wewouldproposetbefollowingconsiderationsaselementsof
a solution.
l. |ntbestrictsenseof tbeterm,accordingto!rencbusage,
tbescienceofanobjectexistsonlyiftbisobjectallowsmeasure-
mentandcausalexplanation,insbort,analysis.Lverysciencetends
towardmetricaldeterminationtbrougbestablisbingconstantsor
invariants.
z. Tbis scientihcpointofviewisanabstractpointofview, it
expressesa cboiceandbencea neglect.Tolookforwbat men's
livedexperienceisinrealityistooverlookwbatvalueitiscapa-
ble of acceptingforandbytbem. before scienceitis tecbnolo-
gies,arts,mytbologiesandreligionswbicbspontaneouslyvalorize
bumanlife.Aftertbeappearanceofsciencetbesesamefunctions
stillexistbuttbeirinevitablecon|lictwitbsciencemustberegu-
latedbypbilosopby, wbicbistbusexpresslypbilosopbyofvalues.
1. Tbelivingbeing,bavingbeenled,inbisbumanity, togive
bimselfmetbodsandaneedtodeterminescientihcallywbatisreal,
necessarilyseestbeambition todeterminewbatisrealextendto
lifeitselfLifebecomes infact,itbasbecomesobistorically,not
bavingalways been so an object ofscience.Tbescienceoflife
hnds tbatitbaslifeassubj ect,sinceitistbeenterpriseofliving
men, andas obj ect.
+. |nseekingtodeterminetbeconstantsandinvariantswbicb
2 2 1
really dehnetbepbenomenaoflife,pbysiologyisgenuinelydoing
tbeworkofscience.butinlookingforwbatistbevitalsignihcance
of tbese constants, inqualifying some as normal and otbers as
patbological,tbepbysiologistdoesmore notless tbantbestrict
work of science. Ue nolongerconsiderslife merely as a reality
identical to itself butas polarizedmovement. Witboutknowing
it,tbepbysiologistnolongerconsiderslifewitbanindifferenteye,
witb tbe eye of a pbysicist studying matter, be considers lifein
biscapacityasalivingbeingtbrougbwbomlife,inacertainsense,
also passes.
.Tbefactistbattbepbysiologist'sscientib cactivity, bowever
separateandautonomousbemayconceiveofitinbislaboratory,
maintainsamoreor lessclose,butunquestionablerelationsbipwitb
medical activity. |t islife's setbackswbicbdraw and bave drawn
attentiontoit. knowledgealwaysbasitssourceinre|lectionona
setbacktolife. Tbisdoes not meantbatscience is arecipefor
processes of action but tbat ontbe contrary tbe rise of science
presupposesanobstacletoaction. | tislifeitself, tbrougbitsdif-
ferentiationbetweenitspropulsiveandrepulsivebebavior,wbich
introduces tbecategoriesofbealtbanddiseaseintobumancon-
sciousness. Tbesecategoriesarebiologicallytecbnicalandsubjec-
tive,notbiologicallyscientihcandobjective. Livingbeingsprefer
bealtbtodisease. Tbepbysicianbas sidedexplicitlywitbtbe liv-
ingbeing,beisintbeserviceoflifeanditislife'sdynamicpolar-
ity wbicb be expresses wben bespeaks of tbe normal and tbe
patbological.Tbepbysiologistisoftenapbysician,alwaysaliving
man, andtbis is wby tbe pbysiologist includes in bis basic con-
cepts tbe facttbat if tbe livingbeing's functions assume modes
allequallyexplicablebytbescientist,tbeyarenotfortbisreason
tbe samefortbe livingbeingbimself.
2 2 2
Tosummarize,tbedistinctionbetweenpbysiologyandpatbology
basandcanonlybaveaclinicalsignib cance.Tbisistbereasonwby,
contraryto allpresentmedicalcustom,wesuggesttbatit is med-
icallyincorrecttospeakof diseasedorgans,diseasedtissues,dis-
eased cells.
Liseaseisbebaviorofnegativevalueforaconcreteindividual
living being ina relationof polarized activitywitbbis environ-
ment. |n tbis sense, itisnotonlyforman altbougbtbe terms
patbological ormalady, tbrougb tbeir relationtopathos ormal,
indicatetbattbesenotionsareappliedtoalllivingbeings tbrougb
sympatbeticregressionstartingfromlivedbumanexperience but
forevery living tbing tbat tbere is only completely organic dis-
ease.Tbereare diseases of tbedogandtbe bee.
Totbeextenttbatanatomicalandpbysiologicalanalysisbreaks
tbeorganismdownintoorgansandelementaryfunctions,ittends
toplacediseaseontbelevelofpartialanatomicalandpbysiologi-
cal conditions of tbetotalstructureorbebaviorasawbole. Le-
pendingontbedegreeof subtletyintbe analysis, diseasewillbe
placedat tbe organ level and it is Vorgagni at tbe tissue
level anditisbicbat attbecellularlevelanditis\ircbow.but
indoingtbiswe forget tbatbistorically, logicallyandbistologi-
callywereacbedtbecellbymovingbackward,startingfromtbe
totalorganism,andtbougbt, ifnottbegaze[le regard], wasalways
turnedtoward it. Tbesolutiontoaproblemposedbytbeentire
organism, hrst to tbe sick man, later to tbe clinician, bas been
sougbtintbetissueorcell.Tolookfordiseaseattbelevelofcells
istoconfusetbeplaneofconcretelife,wberebiologicalpolarity
distinguisbes between bealtbanddisease, witbtbe plane of ab-
stractscience,wberetbeproblemgetsasolution.Wedonotmean
tbatacellcannotbesickifbycellwemeananentirelivingtbing,
as for example aprotistunicellularorganism], butwe do mean
tbattbe living being's diseasedoesnotlodge inparts of tbeor-
2 2
3
ganism. |tiscertainlylegitimatetospeakofasickleucocytej ust
asonebastberigbttoconsidertbeleucocyteoutsideofeveryre-
lationtotbereticulo-endotbelialsystemandtbe conjunctive sys-
tem. butintbiscasetbeleucocyte isconsideredasanorganand
betterasanorganisminadefenseandreactionsituationvis--vis
anenvironment.|nfact,tbeproblemofindividualityisposedbere.
Tbe same biologicalgiven canbeconsideredaspartoras wbole.
Wesuggesttbatitisasawboletbatitcanbe called sickornot.
Cellsoftberenalorpulmonaryorsplenicparencbymacanbe
calledsicktodayorsickwitbacertaindiseasebyacertainanato-
mistorpatbologist,wbobasperbapsneversetfootinabospital
orclinic, onlybecausetbesecellswereremoved,ortbeyresem-
bleoneswbicbwereremoved,yesterdayorabundredyearsago it
doesn'tmatter byapracticingpbysician, clinicianandtberapist,
from tbe cadaveroramputatedorganof amanwbosebebavior
bebad observed. Tbis is sotrue tbatVorgagni, tbe founderof
patbologicalanatomy, inbishneepistletotbesurgeonTrewattbe
begiuningofbisbasicwork, enunciatestbeformalobligationof
anatomicpatbological explorationtoreferconstantlytotbeanat-
omyoftbenormallivingbeing, obviously, butalsoandaboveall
toclinical experience[ 85]. \ircbowbimself,comingto\elpeau's
aidinafamousdiscussioninwbicb!rencbmicrograpbersargued
against bim for tbe specihccbaracterof tbe cancerous element,
proclaimedtbat if tbemicroscope is capable of serving clinical
practice,itisuptoclinicalpracticetoenligbtentbemicroscope
[ 1 1 6]. |tistruetbat\ircbowbaselsewbereandwitbtbegreatest
clarityformulatedatbeoryofdiseaseoftbeparts[maladie parcel
laire] wbicbourprecedinganalysestendtorefute. Lidbenotsay
in 1 895:
|ti smy ideatbattbeessenceofdiseasei samodihedpartof
tbeorganismoramodihedcellormodihedaggregateofcells
2 2
4
(ortissueororgan). . . . |nrealityeverysickpartoftbebodyis
inaparasiticrelationtotberestoftbebealtbybodytowbicb
itbelongsandlivesattbeexpenseoftbeorganism[ 23, 569].
|tseemstbattodaytbisatomisticpatbologybasbeenabandoned
and tbat disease is seenmucbmore as a reactionof everytbing
organic against tbe attack of anelementtbanasanattributeof
tbeelementitself |tispreciselyRickerwbo, in Cermany, istbe
greatopponentof\ircbow'scellularpatbology. Wbatbecalls
tbe'patbologyofrelationsispreciselytbeideatbatdiseasedoes
notexistattbeleveloftbesupposedlyautonomouscellbutcon-
sistsfortbecellintberelationsaboveallwitbtbebloodandner-
vous system, tbat is, witban interior environment anda coordi-
nating organ wbicbmake tbe organism's functioning a wbole
[ 55, / 9]. |tdoesnotmattertbattbecontentofRicker'spatbolog-
ical tbeories seems arguable to Uerxbeimer andotbers, wbat is
interestingistbespiritofbisattack. |nsbo;t,wbenwespeakof
objectivepatbology, wbenwetbinktbatanatomicalandbistolog-
icalobservation,tbepbysiologicaltest,tbebacteriologicalexami-
nation,aremetbodswbicbenabletbediagnosisofdiseasetobave
scientihcsignihcance even, accordingtocertainpeople, intbe
absenceofallclinicalinquiryandexploration weare,inouropin-
ion,victimsoftbemostseriouspbilosopbicaland,tberapeutically
speaking,sometimestbemostdangerousconfusion.Amicroscope,
atbermometer, a culturemediumknownomedicinewbicbtbe
pbysicianwouldnotknow.Tbeygivea result. Tbis resultbasno
diagnosticvalueinitself. |nordertoreacbadiagnosistbesickper-
son's bebaviormust be observed. |t is tben discovered tbat one
wbobasaLhlerbacillusinbispbarynxdoesnotbavedipbtberia.
Ontbeotberband,for anotberman, atborougbandveryaccu-
ratelycarriedoutclinicalexaminationmakesonetbinkofUodg-
kin'sdiseasewbentbepatbologicalexaminationofabiopsyreveals
tbe existence of a tbyroid tumor.
|n patbology tbe hrst word bistoricallyspeaking andtbelast
word logicallyspeakingcomesbackto clinicalpractice. Clinical
practiceisnotandwillneverbeascienceevenwbenitusesmeans
wboseeffectivenessisincreasinglyguaranteedscientihcally. Clin-
icalpracticeisnotseparatedfromtberapeutics, andtberapeutics
isatecbniqueforestablisbingorrestoringtbenormalwboseend,
tbatis, tbe subjectivesatisfactiontbatanormisestablisbed, es-
capestbej urisdictionofobjectiveknowledge. Onedoesnotsci-
entihcallydictatenormstolife. butlife istbispolarizedactivity
of debatewitbtbeenvironment,wbicbfeelsnormalornotde-
pendingonwbetberitfeels tbat itis in a normativepositionor
not.Tbepbysicianbassidedwitblife. >cienceservesbiminmlhlling
tbe duties arising from tbat cboice. Tbe doctor is called by tbe
patient. '|tistbeecbooftbispatbeticcallwbicbqualihesaspatbo-
logicalalltbescienceswbicbmedical tecbnology uses toaidlife.
Tbusitistbattbereisapatbologicalanatomy, apatbologicalpbys-
iology,apatbologicalbistology,apatbologicalembryology. buttbeir
patbologicalqualityisanimportoftecbnicalandtberebysubjective
origin.Tbereisnoobjectivepatbology. >tructuresorbebaviorscan
beobjectivelydescribedbuttbeycannotbecalled'patbological
ontbe strengtbof some purelyobjective criterion. Objectively,
onlyvarietiesordifferencescanbedehnedwitbpositiveornega-
tivevital values.
2 26
Conclusion
| n|artOnewelookedintotbebistoricaloriginsaudanalyzedtbe
logicalimplicationsoftbeprincipleofpatbology, sooftenstillin-
voked, accordingtowbicbtbemorbidstate intbelivingbeingis
onlyasimplequantitativevariationoftbepbysiologicalpbenom-
enawbicbdehnetbenormalstateoftbecorrespondingfunction.
We tbinkwebaveestablisbedtbenarrownessandiuadequacyof
sucbaprinciple. |ntbecourseof tbediscussionandintbeligbt
of tbe examples presented, we tbink we bave furnisbed some
criticalargumentsto supportproposalsofmetbodanddoctrine
wbicbform tbe objectof |artTwoandwbicbwe sballsumma-
rize as follows.
Typesandfunctionscanbequalihedasnormalwitbreference
totbedynamicpolarityoflife. |fbiologicalnormsexistitisbe-
causelife,as notonly subject to tbeenvironmentbutalso as an
institutionofitsownenvironment,tberebypositsvaluesnotonly
intbeenvironmentbutalso intbeorganism itself Tbis is wbat
we call biological normativity.
Witboutbeingabsurd,tbepatbologicalstatecanbecallednor-
maltotbeextenttbatitexpressesarelationsbiptolife'snormativity.
butwitboutbeingabsurdtbisnormalcouldnotbe termediden-
ticaltotbenormalpbysiologicalstatebecausewearedealingwitb
2 2
7
otbernorms.Tbeabnormalisnotsucbbecauseoftbeabsenceof
normality. Tbereisnolifewbatsoeverwitboutnormsoflife,and
tbe morbid state is always a certain mode of living.
Tbepbysiologicalstate is tbebealtbystate, mucbmorethan
tbe normal state. |t is tbe state wbicballows transition to new
norms. Van isbealtby insofaras be is normative relative to tbe
ductuationsofbisenvironment.Accordingtous,pbysiologica|con-
stants bave, among all tbepossib|e vita| constants, a propulsive
value.Tbepatbologicalstate,ontbeotberband,expressestbere-
ductionoftbenormsoflifetoleratedbytbelivingbeing,tbepre-
cariousness of tbe normal establisbedby disease. |atbological
constantsbavearepu|siveandstrictlyconservative value.
Cure istbereconquestof astateof stabilityofpbysiological
norms. |t isa|l tbe closer to bealtbor disease as tbis stabi|ityis
moreorlessopentoeventualcbange.|nanycasenocureisare-
tumtobiologicalinnocence.Tobecuredistobegivennewnorms
oflife, sometimessuperiorto tbe o|d ones. Tbereisanirrevers-
ibility of biological normativity.
Tbeconceptofnormisanoriginalconceptwbicb,inpbysiol-
ogymoretbanelsewbere,cannotbereducedtoanobjectivecon-
cept determinable by scientihcmetbods. >trictlyspeakingtben,
tbereisnobiologicalscienceoftbenormal.Tbereisascienceof
biological situations and conditionscaled normal . Tbat science
is pbysiology.
Tbeattributionofavalueof'normaltoconstantswbosepbys-
iologyscientihcallydeterminestbecontent,expressestberelation
oftbescienceoflifetolife'snormativeactivityand,asfarastbe
scienceofbuman|ifeisconcerned,tobiologicaltecbniquesofpro-
ductionandestablisbmentoftbenormal,andmoreespecia|lyto
medicine.
|tiswitbmedicineaswitba|lotbertecbnologies. |tisanac-
tivityrootedintbelivingbeing'sspontaneouselIorttodominate
2 2 8
CONCLUSION
tbeenvironmentandorganize it according tobis values as aliv-
ingbeing. |tis intbis spontaneousefforttbatmedicine hndsits
meaning,ifnotathrstalltbecriticalclaritywbicbrendersitin-
fallible.Uereiswbymedicine,witboutbeingascienceitself,uses
tberesultsofalltbesciencesintbeserviceoftbenormsoflife.
Tbusitishrstandforemostbecausemenfeelsicktbatamed-
icineexists. |tisonlysecondarilytbatmenknow,becausemedi-
cine exists, inwbatwaytbeyaresick.
Lveryempiricalconceptofdiseasepreservesarelationtotbe
axiological concept of disease. Consequently itis not an objec-
tivemetbodwbicbqualihesa consideredbiologicalpbenomenon
aspatbological. |tisalwaystberelationtotbeindividualpatient
tbrougbtbeintermediaryof clinicalpractice,wbicbjustihestbe
qualihcationof patbological. Wbileadmittingtbeimportanceof
objectivemetbodsofobservationandanalysisinpatbology,itdoes
not seem possible tbatwe can speak witbany correctlogic of
'objectivepatbology. Certainly a patbologycanbemetbodical,
criticalandfortihedexpermentally. |tcanbecalledobjectivewitb
referencetotbepbysicianwbopracticesit. buttbepatbologist's
intentionisnottbat bisobjectbeamatterwitboutsubjectivity.
One cancarryoutobjectively, tbatis impartially, researcbwbose
objectcannotbeconceivedandconstructedwitboutbeingrelated
toapositiveandnegativequalihcation,wboseobjectisnotsomucb
a factas a value.
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S E CT I O N Two
NE W R E F L E C T I O NS O N T H E
NO RMA L A ND T H E
PAT H O L O G I C A L
( 1 9 6 3-1 9 6 6 )
Twe nt
y
Years Later . . .
|n l 9+1 as teacber[charne d'enseinnement ] intbe !acultyof Let-
tersat>trasbourginClermont!errand,|gaveacourseonNorms
and the Normal. At tbe same time | was writingmydoctoraltbe-
sis inmedicine, wbicb| defendedin ]ulyof tbe sameyear,be-
foretbe>trasbourg!acultyof Vedicine. |nl961asprofessorin
tbe!acultyofLettersand>ocial>ciencesat|aris|gaveacourse
ontbesamesubject. twentyyearslater| wantedtomeasuremy-
self against tbe same difhcultiesby otbermeans.
| twasoutoftbequestionsimplytoreexaminetbesameques-
tions. Certainpropositions,wbicb | triedto supportsoundlyin
myEssay becauseof tbeirperbapsonlyapparent paradoxical
cbaracter seemed tome after tbattobe takenforgranted. less
becauseof tbeforceofmyownargumentationtbanbecauseof
tbeingenuityof somereaderswbo werecleverinhndingante-
cedents unknown tome. One yng colleague, ' a hne kant
specialist studyingtbekantian pbilosopby inits relations witb
eigbteentb-centurybiologyandmedicine, pointedouta textto
meof tbekindtbatgenerates atoncetbesatisfactionof agreat
meetingandtbeembarrassmentatanignoranceunderwbosesbel-
teronebelievedonewasabletoclaimforoneselfabitoforigi-
nality. kant noted, more tbanlikelyaround l 79.
Tbeneed tounravel tbeskeinofpoliticsbystartingfrom tbe
subjects'dutiesratbertbantbecitizens'rigbtsbasrecentlybeen
stressed. Likewise itis diseases wbicb bave stimulatedpbysi-
ology, and itis not pbysiology but patbology and clinical
practicewbicbgavemedicineitsstart.Tbereasonistbatasa
matteroffactwell-beingisnotfelt,foritistbesimpleaware-
nessof living, andonlyitsimpedimentprovokestbeforceof
resistance. |tisnowondertbentbatbrownbeginsbyclassify-
ingdiseases.kant,Werke, AkademieAusgabe,l , Anthropologie,
in tbe 'UandscbriftlicberNacblass, p. 964].
becauseoftbisitseemedsuperduoustolookfor newjustib -
cationsfortbetbesiswbicbpresentsclinicalpracticeandpatbol-
ogyastbebreedinggroundinwbicbpbysiologyisrooted,andas
tbepatbonwbicbtbebumanexperienceof diseaseconveys tbe
concept of normal rigbttotbe beartof tbepbysiologist's prob-
lematic. To tbiswasaddedtbefacttbatnewreadingsof Claude
bernard,stimulatedandclarihedbytbe 1 947 publicationoftbe
Principes de medecine experimentale, necessarilysoftenedtbe rigor
oftbejudgmevt| hrstpassedonbisideaoftberelationsbetween
pbysiologyandpatbology, andmadememoresensitivetotbefact
tbatbernarddidnotignoretbeneedforclinicalexperiencetopre-
cedelaboratoryexperimentation.
|f|badtodealwitbbeginners,tbehrsttbing|wouldtelltbem
isgo to tbe bospital, tbat is tbe hrst tbing togetacquainted
witb. !orbowwould oneanalyze diseases,wbicbonedidn't
know,bymeansofexperimentation?Tberefore|amnotsaying
substitutetbelabotatoryfortbebospital. | am sayingtbeop-
posite. gototbebospitalhrst,buttbisisnotenougbtoattain
scientihc orexperimentalmedicine, wemustgo to tbe labo-
ratory afterwards to analyze experimentally wbat clini cal
2
34
TWENTY YEARS LATER . . .
observationbasledustorecord.|cannotimaginewbytbisob-
jectionismadetomefor |baveindeedoftensaidandrepeated
tbatmedicinemustalwaysbeginwitbaclinicalobservation(see
Introduction, p. 242) anditisintbisway tbat itbegan in an-
cient times.
Conversely,bavinggivenbernardbisdue, wbicb|badinpartcon-
tested, | bad to sbow myself, as | also did, ratber lessgenerous
witbregardto Lericbe.
!oralltbesereasons,my 1 963 courseexploredtbesubjectby
tracingdifferentpatbsfromtboseof 1 943. Otberreadingstimu-
latedmyre|lectionsinotberways. |tisnotjustamatterofread-
ingworkswbicbbaveappearedintbeinterim. |tisalsoamatter
ofreadingswbicb|couldbaveorbaddoneattbetime.Tbebib-
liograpby of a subject always bas to beredone,even retrospec-
tively. Onewillunderstandtbisbycomparingevenberetbe1966
bibliograpbywitbtbatof 1943.
buttbetwocoursesonNorms and the Normal byextensionwent
beyondtbesubjectofmedicalpbilosopbydealtwitbbytbeEssay
wbicb|stillintendtoreexamineintbepagestbatfollow.Tbemean-
ing of tbe concepts of norm and normal intbe social sciences,
sociology, etbnology, economics, involveresearcbwbicbintbe
end wbetberitdealswitbsocialtypes, criteria of maladjust-
menttotbegroup, consumerneeds andbebavior, preference
systems tendstowardtbequestionoftberelationsbetweennor-
mality andgenerality. |f at tbe start | borrow some elements of
analysis from tbelectures, inwbicb | examined some aspects of
tbisquestioninmyownway,itisonlytoclarifytbespecihcmean-
ingofvitalnormsbycomparingtbemwitbsocialnorms.|tiswitb
tbeorganisminviewthat| amallowingmyselfsomeforaysinto
society.
Can| confesstbatreadingstudieswrittenaftermy 1 943 tbe-
2
3
5
siswitbasimilarobjectivebasnotconvincedmetbat|myselfposed
tbeproblembadlyattbattime?Alltbosewbo,likeme,aimedat
determiningtbemeaningoftbe conceptofnormalbaveexperi-
encedtbesamedifhcultyand,facedwitbtbeterm'spolysemous
cbaracter,badnootberresourcetbantodeterminedecisivelytbe
meaningwbicbseemedtotbemmostadequatefortbetbeoreti-
cal orpractical projectwbicbcalledupa semanticdelimitation.
Tbisamountstosayingtbattbosewbotbemselvestriedmostrig-
orouslytogive'normalonlytbevalueofafactbavesimplyval-
orized tbefactof tbeir needfora limitedmeaning. Todaytben,
astwentyyearsago,|amstillrunningtberiskoftryingtoestab-
lisbtbefundamentalmeaningoftbenormalbymeansofapbilo-
sopbical analysis of life understoodasactivityof opposition to
inertia andindifference. Lifetries towinagainst deatb inalltbe
sensesof tbe verb to win, foremost in tbe sense of winning in
gambling. Lifegamblesagainstgrowingentropy.
CHAPTER |
From t he Social t o t he Vit al
|ntbeCritique of Pure Reason (intbe1rdsectionoftbe]transcen-
dentalmetbodology.arcbitectonicofpurereason),kantdistin-
guisbesconcepts,accordingtotbeirspbereoforiginandvalidity,
intoscholastic andcosmic, tbe latter serving astbefoundationfor
tbe former.
We could sayof tbetwoconceptsofNormand Normal tbat
tbehrstis scbolastic wbiletbe secondiscosmicorpopular. |t is
possiblefortbenormaltobeacategoryofpopularjudgmentbe-
causetbeirsocialsituationiskeenly,tbougbconfusedly,feltbytbe
peopleasnotbeinginline,not'rigbt(droite). buttbeveryterm
normalbaspassedintopopularlanguageandbasbeennaturalized
tbere starting witb tbespecihcvocabularies of two institutions,
tbepedagogicalinstitutionandtbebospitalwbosereforms,atleast
in!rance,coincidedundertbeeffectoftbesamecause,tbe!rencb
Revolution. 'Normalistbetermusedbytbenineteentbcentury
todesignatetbescbolasticprototypeandtbestateoforganicbealtb.
Tberefonof medicineas tbeory, itself rests ontbereform of
medicineaspractice.in!ranceasalsoinAustri+itiscloselytied
tobospitalreform. Likepedagogicalreform, bospitalreformex-
pressesa demandforrationalization wbicbalso appears inpoli-
tics, as it appears i ntbe economy, undertbe effectof nascent
2
37
industrial mecbanization, and wbicb bnally ends up in wbat bas
since been called normalization.
]ustas anormalscbool is a scbool wbere teacbingis taugbt,
tbatis,wberepedagogicalmetbodsaresetupexperimentally, so
a normal medicine dropper is one wbicb is calibratedto divide
onegramofdistilledwaterintotwentyfree-|lowingdropssotbat
tbe pbarmaco-dynamic powerof a substance in solutioncan be
graduatedaccordingtoamedicalprescription. Again, amongtbe
21 railwaygaugesusedlongagoandnotsolongago,anormaltrack
isonedehnedbytbe1 . 44 metergaugebetweentbeinsidesoftbe
rails, tbat is, tbat track wbicb, at agiven moment of Luropean
industrialandeconomicbistory, seemedtocorrespondtotbebest
compromisesougbtamongseveralinitiallycondictingrequirements
relatedtomecbanics,fuel, trade, tbemilitaryandpolitics. Like-
wise,for tbepbysiologist,man'snormalweigbt,bearinginmind
sex,ageandbeigbt,istbeweigbtcorrespondingtotbegreatest
predictable longevity. `
|n tbe hrst tbree of tbeseexamples, tbe normal seems to be
tbe effect of a cboice and a decisionexternal to tbe obj ectso
qualihed,wbileintbefourtb,tbetermofreferenceandqualihcation
clearlyappearsasintrinsictotbeobject,ifitistruetbatanindi-
vidualorganism'slife spanisa specihc constantwberebealtbis
maintained.
butwbenwetbinkaboutitcarefully,tbenormalizationoftbe
tecbnicalmeansofeducation,bealtb,transportationforpeopleand
goods,expressescollectivedemandswbicb,takenasawbole,even
intbe absence of anactofawareness[prise de conscience] on tbe
partofindividuals,inagivenbistoricalsociety, dehnesitswayof
referring its structure, or perbaps its structures,towbatitcon-
siders its owngood.
|nanycasetbepropertyofanobjectorfact,callednorma|in
reference to anexternal or immanentnorm,is tbeabilityto be
FROM THE SOCIAL TO THE VITAL
considered,inits turn,astbereferenceforobjectsor|actswbicb
baveyettobeinapositiontobecalledsucb.Tbenormalistben
atoncetbeextensionandtbeexbibitionoftbenorm.|tincreases
tbe ruleattbesame time tbat it points itout. |tasksforevery-
tbing outside, beside and against it tbat still escapes it. A norm
draws itsmeaning, functionand value fromtbefactof tbeexis-
tence, outside itself, of wbatdoes notmeettberequirementit
serves.
Tbenormal isnotastaticorpeaceful,butadynamicandpo-
lemicalconcept. Castonbacbelard,wbowasverypreoccupiedwitb
values intbeircosmicorpopularformandinvalorizationfollow-
ing tbeaxes of tbe imagination, basrigbtlyperceivedtbatevery
value must be earned against an anti-value. |t is be wbo writes.
Tbewilltocleanserequiresanadversaryitssize.
,,
Wbenweknow
tbatnorma istbe LatinwordforT-squareand tbatnormalis means
perpendicular,weknowalmostalltbatmustbeknownabouttbe
area in wbicb tbe meaning of tbe terms 'norm and 'normal
originated, wbicbbave been taken into agreat variety of otber
areas.Anorm,orrule,iswbatcanbeusedtorigbt,tosquare,to
straigbten. To set a norm (normer), to normalize, is to impose a
requirementonaneistence,agivenwbosevariety,disparity,witb
regard totberequirement, presenttbemselvesasa bostile, even
moretbananunknown,indeterminant. |t is, ineffect,apolemi-
calconceptwbicbnegativelyqualihestbesectoroftbegivenwbicb
doesnotenterintoitsextensionwbileitdependsonitscompre-
bension.Tbeconceptofrigbt,dependingonwbetberitisamat-
terofgeometry, moral ity or tecbnology, qualib es wbat offers
resistanceto its application of twisted, crooked orawkward.'
Tbe reason fortbe polemical hnal purposeand usage of tbe
conceptof norm must besougbt,asfaraswe areconcerned,in
tbeessenceoftbenormalabnormalrelationsbip. |tisnotaques-
tionofarelationsbipofcontradictionandexternalitybutoneof
2
3
9
inversionandpolarity Tbenorm,bydevaluingeverytbingtbattbe
referencetoitprobibitsfrombeingconsiderednormal,createson
itsowntbepossibilityofaninversionofterms.Anormoffersit-
selfasapossiblemodeofunifyingdiversity,resolvingadifference,
settlingadisagreement. buttoofferoneselfisnottoimposeone-
self. Unlike a lawof nature, a norm does not necessitate its ef-
fect. Tbat is tosay,a norm bas no signihcanceas norm pureand
simple. because we aredealingwitbpossibilityonly, tbatpossi-
bilityofreferenceandregulationwbicbtbenormoffersleavesroom
foranotberpossibility,wbicbcan onlybeitsopposite.A norm is
ineffecttbe possibilityof a referenceonlywben it bas beenes-
tablisbedorcbosenastbeexpressionofapreferenceandastbe
instrumentofawilltosubstituteasatisfyingstateofaffairsfora
disappointingone. Lverypreferenceforapossibleorderisaccom-
panied,mostoftenimplicitly,bytbeaversionfortbeoppositepos-
sibleorder.Tbatwbicbdivergesfromtbepreferableinagivenarea
ofevaluationisnottbeindierentbut tberepulsiveormoreex-
actly,tberepulsed,tbedetestable. |tiswellunderstoodtbatagas-
tronomical norm does not enter into a relation of axiological
oppositionwitbalogicalnorm.Ontbeotberband,tbelogicalnorm
inwbicbtbetrueprevailsovertbefalsecanbeinvertedintoanorm
wbere tbefalseprevailsovertbe true,astbeetbicalnorm,wbere
sincerityprevailsoverduplicity,canbeinvertedintoanormwbere
duplicityprevailsoversincerity Yettbeinversionofalogicalnorm
does notyieldalogical,butperbapsanaestbeticnorm,astbein-
versionofanetbicalnormdoesnotyieldanetbical,butperbaps
apoliticalone. |nsbort,norms,wbetberinsome implicitorex-
plicitform,refertberealtovalues,expressdiscriminationsofquali-
ties inconformitywitb tbe polar oppositionof a positive and a
negative. Tbis polarity of the experience of normalization, a
specihcallyantbropologicalorculturalexperience ifitistrue
tbatbynature,onlyanidealofnormalitywitboutnormalization
mustbeunderstood buildsintotberelationsbipoftbenormto
its area of application tbenormalpriorityof infraction.
|nantbropologicalexperienceanormcannotbeoriginal. Rule
beginstoberuleonlyinmakingrulesandtbisfunctionofcorrec-
tionarisesfrominfractionitselfAgoldenage,aparadise,aretbe
mytbicalrepresentationsofanexistencewbicbinitiallymeetsits
demands,ofamodeoflifewboseregularityowesnotbingtotbe
establisbment of rules, ofa stateofguiltlessness intbe absence
oftbeinterdicttbatignoranceoftbelawisnoexcuse.Tbesetwo
mytbsproceedfromanillusionofretroactivityaccordingtowbicb
originalgoodislaterevilkeptincontrol.Tbeabsenceofrulesgoes
bandinbandwitbtbeabsenceoftecbnicalskills. Coldenageman,
andparadisiacalman, spontaneouslyenjoytbefruitsof anature
wbicbisuncultivated,unprompted,unforced,unreclaimed. Nei-
tberworknorculture,sucbistbedesireofcompleteregression.
Tbisformulationinnegativetermsofanexperienceconsonantwitb
tbe norm witbout tbenorm bavingbadto sbow itselfinandby
itsfunction, tbisreallynaivedreamofregularityintbe absence
of rule, signihes essentially tbat tbe concept of normal is itself
normative,itservesasanormevenfor tbeuniverseofmytbical
discoursewbicbtells tbestoryofitsabsence.Tbisexplainswby,
inmanymytbologies,tbe adventoftbegoldenagemarkstbeend
ofacbaos.AsCastonbacbelardsaid. "Multiplicit is agitation. | n
literaturetberei snotoneimmobile chaos" Lop. cit. , p. 59]. |nOvid's
Metamorphoses tbe eartb of cbaosdoes notbearfruit, tbe seaof
cbaosisnotnavigable,formsdonotremainidenticaltotbemselves.
Tbeinitialindeterminationislaterdenieddetermination.Tbein-
stabilityoftbingsbasasitscorrelativetbeimpotenceofman. Tbe
imageofcbaosistbatofadeniedregularity,astbatoftbegolden
age istbatof wild[sauvage] regularity. Cbaosandgoldenageare
tbemytbicaltermsoftbefundamentalnormativerelation,terms
sorelatedtbatneitberoftbetwocankeepfromturningintotbe
otber. Tbe roleof cbaos isto summon up, toprovoke its inter-
ruptionandtobecomeanorder. |nversely,tbeorderoftbegolden
agecannotlastbecausewildregularityismediocrity, tbe satisfac-
tions tberearemodest aurea mediocritas - because tbeyare not
a victorygained over tbeobstacle of measure. Wbere a rule is
obeyedwitboutawarenessofapossibletranscendence,allenjoy-
mentissimple. butcanonesimplyenjoytbevalueofruleitself
|nordertotrulyenj oy tbevalueoftberule,tbevalueofregula-
tiou,tbevalueof valorization, tberulemustbesubjectedtotbe
testofdipute. |tisnotj usttbeexceptionwbicbprovestberule
asrule,itistbeinfractionwbicbprovidesitwitbtbeoccasionto
berulebymakingrules.|ntbissensetbeinfractionisnottbeori-
ginoftberulebuttbeoriginofregulation.|tisintbenatureof
tbe normativetbat its beginning lies in its infraction.Touse a
kantianexpression,we would proposetbat tbeconditionoftbe
possibilityof rules isbut one witbtbeconditionoftbepossibil-
ity of tbe experience of rules. |nasituationof irregularity, tbe
experienceofrulesputstbe regulatoryfunctionof rulesto tbe
test.
Wbateigbteentb-centurypbilosopberscalledtbestateofna-
tureistbesupposedlyrationalequivalentof tbegoldenage.We
mustrecognizewitbLvi->trausstbatRousseau,unlikeLiderot,
nevertbougbttbattbestateofnaturewasabistoricaloriginfor
bumanity brougbttotbeetbnograpber'sattentionbytbegeogra-
pber'sexploration. !orbispart" ]ean>tarobinskibassbownsuc-
cessfullytbattbestateofnaturedescribedbyRousseauistbepor-
trayalofspontaneousequilibriumbetweentbeworldandtbevalues
ofdesire,astateofprebistoricbapbazardnessintbeabsolutesense
of tbe term, sinceitisfromits irremediable disintegration tbat
bistory owsasfromasource. >trictlyspeaking,tben,tbereisno
grammaticaltenseadequatefor adiscussionofabuman experi-
ence wbicb bas been normalized witbouttbe representation, in
tbe consciousness,of norms linked totbe temptationtooppose
tbeirexercise. !or,eitbertbeadequationof factandlawisun-
pe
ceivedandtbestateofnatureisastateofunawarenessofwbicb
no event can explain tbat from itstems tbe occasion of agrasp
ofconsciousness , or,tbeadequationisperceivedandtbestateof
nature isa state of innocence. but tbis statecannot existforit-
self andbea stateattbesametime,tbatis,astaticdisposition.
Nooneinnocentlyknowstbat be isinnocentsincebeingaware
of adequatio
n totbe rule means being aware of tbe reasonsfor

tberulewbicbamountstotbeneedfortberule.|tisappropriate
tocontrasttotbeoverlyexploited>ocraticmaximtbatnoknow
ingm
n is evil, tbe opposite maxim tbat no
ne is good wbo is
awareofbeingso. >imilarlynooneisbealtbywbokuowstbatbe
isso. kant'swords.'Well-beingisnotfeltforitistbesimplecon-
sciousnessofliving'
areecboedbyLericbe'sdeb nition.'Uealtb
islifeintbesilenceoftbeorgans. butitisintberageofguiltas
intbeclamorof sufferingtbat innocence andbealtbariseastbe
terms of a regression as impossible as it is sougbt after.
Tbeabnormal,asab-normal,comesaftertbedehnitionoftbe
normal, it is its logical negation. Uowever, itis tbe bistori cal
anteriorityof tbefuture abnormalwbicbgivesrisetoa norma-
tiveintention.Tbenormalistbeeffectobtainedbytbeexecution
oftbenormativeproj ect, itistbenormexbibitedintbefact. |n
tberelationsbipoftbefacttbereistbenarelationsbipofexclu-
sionbetweentbenormalandtbe abnormal. buttbisnegationis
subordinatedtotbeoperationofnegation,totbecorrectionsum-
monedupbytbeabnormality. Consequentlyitisnotparadoxical
to say tbat tbe abnormal, wbile logically second, is existentially
hrst.
2
43
Tbe Latin wordnorma wbicb,etymologicallyspeaking, bears tbe
weigbtoftbeinitialmeaningoftbeterms 'normsand'normal,
istbeequivalentoftbeCreek bp{o. Ortbograpby!rencb,ortho-
8raphe, butlongagoortho8raphie], ortbodoxy, ortbopedics,arenor-
mativeconceptsprematurely. |f tbe conceptofortbology is less
familiar,atleastitisnotaltogetberuselesstoknowtbat|latoguar-
anteedit' ' andtbewordisfound,witboutareferencecitation,in
Littr'sDictionnaire de la lan8ue jranaise. Ortbology isgrammar
intbesensegivenitbyLatinandmedievalwriters,tbatis,tbereg-
ulationof language usage.
|fitistruetbattbeexperienceofnormalizationisaspecihcally
antbropological or cultural experience, itcan seem normal tbat
languagebasproposedoneofitsprimeheldsfortbisexperience.
Crammarfurnisbesprimematerialforredectiononnorms.Wben
!rancis| intbeedictof \illers-Cottertordainstbatalljudicial
actsoftbekingdombedrawnupin!rencb,wearedealingwitb
animperative.' butanormisnotanimperativetodosometbing
underpainofjuridical sanctions. Wbentbegrammariansof tbe
sameeraundertooktohxtbeusageoftbe!rencblanguage,itwas
aquestionofnorms,ofdeterminingtbereferenceandofdehning
mistakesintermsofdivergence,difference.Tbereferenceisbor-
rowedfromusage. |ntbemiddleoftbeseventeentbcenturytbis
is\augelas'stbesis. 'Usageistbattowbicbwemustsubj ectour-
selvesentirelyinourlanguage.
, ,
'
\augelas'sworksturnupintbe
wakeofworksoftbeAcadimie jram;aise wbicbwasfoundedpre-
ciselyto embellisbtbe language. |nfactintbeseventeentbcen-
turytbegrammaticalnormwastbeusageofcultured,bourgeois
|arisians, sotbattbisnormredectsa political norm. administra-
tivecentralizationfortbeLenehtofroyalpower.|ntermsofnor-
malization tbere isno differencebetween tbe birtbof grammar
in!ranceintbeseventeentbcenturyandtbeestablisbmentoftbe
metric systemattbeendoftbeeigbteentb. Ricbelieu,tbemem-
bersoftbeNationalConventionandNapoleonbonapartearetbe
successive instruments of tbe same collective demand. |t began
witbgrammaticalnormsandendedwitbmorpbologicalnormsof
men andborsesfornationaldefense, ' passingtbrougb industrial
andsanitary norms.
Leb ning industrialnorms assumes a unityof plan, direction
ofwork, statedpurposeofmaterial constructed.Tbearticleon
'Cun-carriageintbeEnccopedie ofLiderotandd' Alembert,re-
vised bytbeRoyal Artillery Corps, admirably sets fortbtbemo-
tifsoftbenormalizationofworkinarsenals. |nitweseebowtbe
confusionofefforts,tbedetailofproportions,tbedifhcultyand
slowness of replacements, useless expense,are remedied. Tbe
standardizationofdesignsofpiecesanddimensiontables,tbeim-
positionofpatternsandmodelsbaveastbeirconsequencetbepre-
cision of separate producs andtberegularityof assembly. Tbe
'Cun-carriagearticlecontainsalmostalltbeconceptsusedina
moderntreatiseonnormalizationexcepttbetermnorm. Uerewe
bave tbe tbingwitbout tbeword.
Tbedehnitionofsanitarynormsassumestbat,fromtbepolit-
icalpointofview,attentionispaidtopopulations'bealtbconsid-
eredstatistically,totbebealtbinessofconditionsofexistence,and
totbeuniformdisseminationofpreventiveandcurativetreatments
perfectedbymedicine. |nAustriaVariaTberesaand ]osepb11 con-
ferredlegalstatusonpublicbealtbinstitutionsbycreatingan|m-
perialUealtbCommission(Sanitits-Hcdeputation, 1 753) andby
promulgatingaHaupt Medizinal Ordnuns, replacedin1 770 bytbe
Sanitits-normativ, anactwitb40 regulationsrelatedtomedicine,
veterinaryart,pbarmacy,tbetrainingofsurgeons,demograpbical
and medical statistics. Witb respectto norm and normalization
bere we bave tbewordwitbtbe tbing.
|n botbof tbese examples tbe norm iswbat determines tbe
normalstartingfromanormativedecision.Aswearegoingtosee,
sucb a decision regarding tbis ortbat norm is understoodonly
witbintbecontextofotbernorms.Atagivenmomenttbeexpe-
rienceofnormalizationcannotbebrokendown,atleastnotinto
projects. |ierreCuiraudclearlyperceivedtbisintbecaseofgram-
mar wben bewrote.
Ricbelieu'sfoundingoftbeAcademie jraf;aise inl 61btintoa
general policyofcentralization of wbicb tbeRevolution, tbe
Lmpire, andtbeRepublicaretbebeirs. . . . |twouldnotbeab-
surdtotbinktbattbebourgeoisieannexedtbelanguageattbe
same time that it seized tbe instruments of production.' `
|tcouldbesaidinanotberwaybytryingtosubstituteanequiv-
alentfortbeVarxistconceptoftbeascendingclass.betweenl79,
wbentbeword 'normal appeared, and l 1+ wben tbeword
'normalizedappeared,anormativeclassbadwontbepowerto
identi[ abeautifulexampleofideologicalillusion tbefunction
of social norms, wbose content itdetermined, witbtbeusetbat
tbat class made of tbem.
Tbattbenormativeintentioninagivensocietyinagivenera
cannot be broken down is apparent wben we examine tbe rela-
tions between tecbnologicalandj uridical norms. |n tberigorous
andpresentmeaningoftbeterm,tecbnologicalnormalizationcon-
sists in tbe cboice anddetermination of material, tbe form and
dimensionsofan object wbose cbaracteristicsfromtbenon be-
comenecessaryforconsistentmanufacture.Tbedivisionoflabor
constrains businessmen toabomogeneityofnorms at tbebeart
ofatecbnicaleconomiccomplexwbosedimensionsareconstantly
evolving ona national orinternational scale. but tecbnologyde-
velopswitbinasociety'seconomy. Ademandtosimplifycanap-
pearurgentfromtbetecbnologicalpointofviewbutitcanseem
prematurefromtbeindustrialandeconomicpointofviewasfar
FROM THE SOCIAL TO THE VI TAL
as tbepossibilitiesof tbe moment andtbe immediate futureare
concerned.Tbelogicoftecbnologyandtbeinterestsoftbeecon-
omymustcometo terms. Voreover, inanotberrespect,tecbno-
logicalnormalizationmustbewareofanexcessofrigidity. Wbat
ismanufacturedmustbnallybeconsumed. Certainlytbelogicof
normalizationcanbepusbedasfarastbe normalizationofneeds
bymeansoftbepersuasionofadvertising.Joralltbat,sbouldtbe
questionbesettledastowbetberneedisanobjectofpossiblenor-
malizationortbesubjectobligedtoinventnorms?Assumingtbat
tbehrstoftbesetwopropositionsistrue,normalizationmustpro-
videfor needs, asitdoesforobjectscbaracterizedbynorms,mar-
gins fordivergence,but berewitboutquantihcation.Tberelation
oftecbnologytoconsumption introducesintotbeunihcationof
metbods,models, procedures andproofsof qualihcation,arela-
tive|lexibility, evokedfurtbermorebytbeterm 'normalization,
wbicb was preferred i n!rance i n1 930 to'standardization, to
designate tbe administrative organism responsibleforenterprise
onanationalscale.' Tbeconceptofnormalizationexcludestbat
ofimmutability, includes tbeanticipationofapossibledexibility.
>owe seebowatecbnologicalnormgraduallyredectsan ideaof
society and its bierarcby of values, bowa decisionto normalize
assumestberepresentationofapossiblewboleofcorrelative,com-
plementaryorcompensatorydecisions.Tbiswbolemustbehnisbed
inadvance,hnisbedifnotclosed. Tberepresentationof tbis to-
talityofreciprocallyrelativenormsisplanning.>trictlyspeaking,
tbeunityofa|lanwouldbetbeunityofauniquetbougbt.Abu-
reaucratic andtecbnocraticmytb, tbe |lan is tbemoderndress
of tbe idea of |rovidence. As it isveryclear tbat a meetingof
delegates andagatberingofmacbinesare bard put toacbieve a
unity of tbougbt, itmust beadmittedtbatwe would besitateto
sayoftbe|lanwbatLa!ontainesaidof|rovidence,tbatitknows
wbatwe needbettertbanwedo.' 'Nevertbeless andwitboutig-
2
47
noringtbefacttbatitbasbeen possibletopresentnormalization
andplanningascloselyconnectedtoawareconomyortbeecon-
omyof totalitarian regimes wemustseeaboveall inplanning
endeavorstbeattemptstoconstituteorganstbrougbwbicbaso-
cietycouldestimate,foreseeandassumeitsneedsinsteadofbeing
reducedtorecordingandstatingtbemintermsofaccountsand
balance sbeets. >o tbat wbatis denounced, under tbe name of
rationalization tbebogeycomplacentlywavedbytbecbampions
of liberalism, tbe economic variety of tbe cultof nature as a
mecbanizationof social life, perbapsexpresses, ontbecontrary,
tbeneed,obscurelyfeltby society, to becometbeorganicsubject
ofneeds recognizedas sucb.
|tiseaytounderstandbowtecbnologicalactivityanditsnor-
malization,intermsof tbeirrelationtotbeeconomy,arerelated
totbejuridicalorder.Alawofindustrialproperty,j uridicalpro-
tectionof patents orregisteredpatterns, exists.Tonormalize a
registeredpatternistoproceedto industrialexpropriation. Tbe
requirement of national defense is tbe reason invoked by many
>tatestointroducesucbprovisions into legislation.Tbeuniverse
oftecbnologicalnormsopensontotbeuniverseofjuridicalnorms.
Anexpropriationiscarriedoutaccordingtotbenormsoflaw.Tbe
magistrates wbo decide, tbe bailiffs responsibleforcarrying out
tbesentence,arepersons identihedwitbtbeirfunctionbyvirtue
ofnorms,installedintbeirfunctionwitbtbedelegationofcom-
petence. Ueretbenormaldescendsfromabigbernormtbrougb
bierarcbizeddelegation.|nbisReine Rechtslehre (Leipzig,F Leuticke,
1 934, znd revised and enlarged edition, 1 960; translatedas Pure
Theory c Law, zndrevisedandenlargededitionberkeley, Univer-
sityof California|ress,1 967), kelsenmaintainstbat tbevalidity
ofaj uridicalnormdependsonitsinsertioninacoberentsystem,
anorderofbierarcbizednorms,drawingtbeirbindingpowerfrom
tbeirdirectorindirectreferencetoafundamentalnorm.buttbere
aredifferentj uridicalordersbecausetbereareseveralfundamen-
tal,irreduciblenorms.|fitbasbeenpossibletocontrasttbispbi-
losopbyoflawwitbitspowerlessnesstoabsorbpoliticalfactinto
juridicalfact,asitclaimstodo,atleastitsmeritinbavingbrougbt
toligbttberelativityofjuridicalnormsbierarcbizedina cober-
entorderbas beengenerallyrecognized. >otbat oneof kelsen's
most resolute critics can write. 'Tbe law is tbe system of con-
ventionsandnormsdestinedtoorientallbebaviorinsideagroup
inawell-dehnedmanner. ' Lvenwbilerecognizingtbattbelaw,
privateaswellaspublic,bas nosourceotbertbanapoliticalone,
wecanadmittbattbeopportunitytolegislateisgiventotbeleg-
islative powerbyamultiplicityof customs wbicbmustbeinsti-
tutionalizedbytbatpowerintoavirtualjuridicalwbole. Lvenin
tbeabsenceoftbeconceptofjuridicalorder,deartokelsen,tbe
relativityofjuridicalnormscanbejustihed.Tbisrelativitycanbe
moreorlessstrict.Tbereexistsatolerancefornon-relativitywbicb
does notmean agap inrelativity. |n facttbenormofnorms re-
mainsconvergence.Uowcoulditbeotberwiseiflaw'isonlytbe
regulation of social activity?
, ,
' "
To sumup, startingwitbtbe deliberatelycbosenexampleof
tbemostartihcialnormalization,tecbnologicalnormalization,we
cangraspaninvariablecbaracteristicofnormality. Normsarerel-
ative to eacb otber in a system, at least potentially. Tbeir co-
relativity witbin a social systemtends to make tbissysteman
organization,tbatis,aunityinitself, if notbyitselfandfor it-
self. Onepbilosopber, atleast, bas noticedandbrougbtto ligbt
tbe organic cbaracterof moral norms, mucbas tbeyare hrstof
allsocial norms. |tisbergson inLes deux sources de la morale et de
la religion 'TbeTwo >ourcesof VoralityandReligion]analyz-
ingwbat be calls 'tbe totalityof obligation.
Tbecorrelativityofsocialnorms tecbnological,economic,jur-
idical tendstomaketbeirvirtualunityanorganization.|tisnot
easytosaywbattbeconceptoforganizationisinrelationtotbat
of organism,wbetberwe are dealingwitbamoregeneral struc-
turetbantbeorganism,botbmoreformalandricber,orwbetber
earedealingwitbamodelwbicb,relativetotbeorganismbeld
asabasictypeofstructure,basbeensingularizedbysomanyre-
strictiveconditionstbatitcouldbavenomoreconsistencytbana
metapbor.
Letusstatehrsttbatinasocialorganization,tberulesforad-
justingtbepartsintoacollectivewbicbismoreorlessclearasto
itsownhnalpurpose betbepartsindividuals,groupsorenter-
priseswitbalimitedobjective areexternaltotbeadjustedmul-
tiple. Rulesmustberepresented,learned,remembered,applied,
wbileinalivingorganismtberulesforadjustingtbepartsamong
tbemselves are immanent, presentedwitbout beingrepresented,
actingwitbneitberdeliberationnorcalculation. Ueretbereisno
divergence,nodistance,nodelaybetweenruleandregulation. Tbe
socialorderisasetofruleswitbwbicbtbeservantsorbenehciaries,
inany case, tbeleaders, must beconcerned. Tbeorderof life is
made of a setof rules livedwitbout problems.
TbeinventoroftbetermandhrstconceptofsocioloBY, August
Comte, intbe lectures of tbe Cours de philosophie positive, wbicb
dealwitbwbatbethencalledsocialpbysics,didnotbesitatetouse
tbeterm'socialorganismtodesignatesocietydehnedasaconsensus
ofpartscoordinatedaccordingtotworelations,synergyandsym-
patby, conceptsborrowedfromtbeUippocraticmedicaltradition.
Organization,organism,system,consensus areusedindifferentlyby
Comtetodesignatetbestate ofsociety. ' Asfarbackas tbatpe-
riod,Comtedistinguisbedbetweensocietyandpower,understand-
ingtbelatter concept astbeorganandregulatorofspontaneous
commonaction, anorgandistinctbutnotseparatefromtbeso-
cialbody, arational, artibcial butnotarbitraryorganoftbe'ma-
nifest spontaneous barmony wbicb must always tend to rule
betweentbewboleandtbepartsoftbesocialsystem.
, ,
Tbustbe
relationsbipbetweensocietyandgovernmentisitselfarelation-
sbipof correlation,andtbepoliticalorderappearsastbevolun-
taryandartib cialextension'oftbisnaturalandinvoluntaryorder
toward wbicb tbe various bumansocietiesnecessarilyandinces-
santlytend inanyrespect.
, ,
Wemust wait for tbeSysteme de politique positive inorderto

seeComtelimittbescopeoftbeanalogybeacceptedintbeCours
andtoempbasizetbedifferences wbicb keep onefromconsider-
ingasequivalenttbestructureofanorganismandtbestructure
ofasocialorganization.|ntbebftbcbapter('Tboriepositivede
l'organisme social) of tbe Statique sociaJe ( l z), Comte insists
ontbefacttbattbecompositenatureof tbecollectiveorganism
differsprofoundlyfromtbeindivisibleconstitutionoftbeorgan-
ism. Tbougb functionallyconcurrent, tbe elements of tbe social
bodyare capableof aseparate existence. |ntbis respecttbe so-
cialorganismdoescontainsomemecbanisticcbaracteristics.|ntbe
samerespect,moreover, 'tbecollectiveorganism,becauseof its
compositenature,possessestoabigberdegreetbeimportantap-
titude, wbicb tbe individualorganismsbows onlyinarudimen-
tarystate,namelytbeabilitytoacquirenew,evenessentialorgans.
,,
`
becauseoftbis,regulation,tbeintegrationofsuccessivelyrelated
partsintoawbole,isaspecihcsocial need.Toregulatetbelifeof
a society, familyorcity isto introduce intoa society atonce
moregeneralandmorenoblebecauseclosertotbeonlyconcrete
socialreality UumanityorCreat-being. >ocialregulationisre-
ligion and positive religion is pbilosopby, spiritual power, tbe
general art of man's action on bimself. Tbis function of social
regulationmustbaveadistinctorgan,tbepriest,wbosetemporal
powerismerelya subordinatemeans. >ocially speaking, toregu-
late is to cause tbe spiritof tbe wbole to prevail. >o tbat tbe
entiresocialorganism,ifitissmallertbantbeCreat-being,isreg-
ulatedfromwitboutandfromabove. Tberegulatorissubsequent
towbatitregulates.'|neffectonlypreexistingpowerscanbereg-
ulated,exceptinstancesofmetapbysicalillusionwberewebelieve
we create tbem to tbeextent tbatwe dehne tbem.
, , 26
We sball say otberwise certainly not better, probablyless
well namelytbatasocietyisbotbmacbineandorganism.|twould
beonlyamacbineiftbecollective'sendscouldnotonlybestrictly
plannedbut also executedinconformitywitbaprogram. |n tbis
respectcertain contemporary societieswitba socialistform of
economytendperbapstowardan automatic mode of function-
ing.butitmustbeacknowledgedtbattbistendencystillencoun-
ters obstacles in facts, and notj ust in tbe ill will of skeptical
performers,wbicbobligetbeorganizerstosummonuptbeirre-
sourcesforimprovisation. | tcanevenbeaskedwbetberanysoci-
etywbatsoeveriscapableofbotbclearsigbtednessindetermining
itspurposes andefhciencyinutilizingits means. |n any case tbe
facttbat oneof tbetasks of tbeentire social organization con-
sists initsinforming itself asto itspossible purposes witbtbe
exceptionofarcbaicandso-calledprimitivesocietieswberepur-
poseisfurnisbedinriteandtraditionj ustastbebebavioroftbe
animalorganismisprovidedbyaninnatemodel seemstosbow
clearlytbat,strictlyspeaking,itbasnointrinsichnality. |ntbecase
ofsociety, regulationisaneedinsearcbofitsorgananditsnorms
of exercise.
Ontbeotberband,intbecaseoftbeorganismtbefactofneed
expresses tbe existence of aregulatoryapparatus. Tbe needfor
food, energy, movementandrestrequires, as a condition of its
appearanceintbeform of anxietyandtbeactof searcbing, tbe
referenceoftbeorganism,inastateofgivenfact,toanoptimum
stateoffunctioning,determinedintbeformofaconstant.Anor-
ganicregulationofabomeostasisassureshrstofalltbereturnto
tbeconstant wben,becauseofvariationsinitsrelationtotbeen-
vironment, tbeorganismdivergesfrom it. ]ustasneedbasas its
center tbe organism taken in its entirety, even tbougb itmani-
festsitselfandissatishedbymeansofoneapparatus,soitsregu-
lationexpressestbeintegrationofparts witbintbewboletbougb
itoperates bymeans ofonenervousandendocrine system. Tbis
istbereasonwby, strictlyspeaking,tbereisnodistancebetween
organswitbintbeorganism,noexternalityof parts. Tbeknowl-
edgetbeanatomistgainsfromanorganismisakindofdisplayin
extensiveness.buttbeorganismitselfdoesnotliveintbespatial
mode by wbicbitisperceived. Tbe life of a living being is, for
eacbof its elements, tbe immediacy of tbe co-presenceof all.
Tbe pbenomenaof social organization are like a mimicry of
vitalorganizationintbesensetbatAristotlesaystbatartimitates
nature.Ueretoimitatedoesnotmeantocopybuttotendtore-
discovertbe sense of a production. >ocialorganization is, above
all, tbe invention of organs organs to look forandreceive in-
formation,organstocalculateandevenmakedecisions.|utbestill
ratbersummarilyrationalformtbatittakesincontemporaryin-
dustrialsocieties, normalizationsummonsupplanningwbicb,in
itsturn, requirestbeestablisbmentof statisticsof allkinds and
tbeir utilization tbrougb computers. |rovidedtbat itispossible
toexplain otbertbanmetaphorically tbefunctioningofacir-
cuit of cortical neurons usingtbe functioningof an electronic
analyzerintransistorformasamodel,itistempting,ifnotlegit-
imate,todaytoattributesome,perbapstbelessintellectualfunc-
tionsforwbicbtbebumanbrainistbeorgan, totbecomputers
iutbetecbnico-economicorganizationstbeyserve.Asfortbeas-
similationof socialinformationbymeansofstatisticsbeinganal-
ogous to tbe assimilationofvital informationby meansofsense
receptors,toourknowledgeitisolder.|twasCabrielTarde,wbo,
in l 90inLes iois de l 'imitation, wastbe hrst toattemptit. 'Ac-
cordingtobimstatisticsistbesummationofidenticalsocialele-
ments.Tbespreadingofitsresultstendstoyielditscontemporary
'intelligence about tbe socialfactin tbe processofbeingreal-
ized.Wecanimagine, tben, a statistical department and its role
asasocialsenseorganaltbougbfor tbemoment,saysTarde,itis
onlyakindofembryoniceye. |tmustbenotedtbattbeanalogy
proposedbyTarderestsontbeconceptiontbatpbysiologicalpsy-
cbologybadattbattimetbefunctionofasensereceptor,liketbe
eyeorear, accordingto wbicbsensiblequalities sucbas coloror
soundsyntbesizetbecomponentsofastimulantintoonespecihc
unitwbicbtbepbysicistcountsinamultiplicityofvibrations. >o
tbatTardecouldwritetbat'oursenses,eacboneseparatelyand
from its special point ofview,makes our statistics of tbeexter-
nal universe.
buttbedifferencebetweentbesocialmacbineryforreceiving
andelaboratinginformation,ontbeoneband,andtbelivingorgan
ontbe otber,stillpersistsintbattbeperfectingofbotbintbecourse
ofbumanbistoryandtbeevolutionoflife, takesplaceaccording
toinversemodes. Tbebiologicalevolutionoforganismsbaspro-
ceededbymeans of stricterintegrationoforgansandfunctions
forcontactwitbtbeenvironmentandbymeansofamoreauton-
omous internalization of tbe conditions of existence of tbe
organism's components and tbe establisbmentof wbat Claude
bernardcalledtbe'internalenvironment. Wbereastbebistori-
calevolutionofbumansocietiesbasconsistedintbefacttbatcol-
lectivitieslessextensivetbantbespeciesbavemultipliedand,as
itwere,spreadtbeirmeansofactioninspatialextemalityandtbeir
institutionsinadministrativeexternality,addingmacbinesto tools,
stocks to reserves, arcbives to traditions. |nsociety tbe so|ution
toeacbnewproblemofinformationandregulationissougbtin,
if not obtainedby, tbe creation of organisms or institutions
2
54
FROM THE SOCIAL TO THE VI TAL
'parallel to tbose wbose inadequacy, because of sclerosis and
routine,sbowsupatagivenmoment.>ocietymustalwayssolvea
problemwitbout a solution, tbat of tbe convergence of parallel
solutions.!acedwitbtbis,tbelivingorganismestablisbesitselfpre-
ciselyastbesimplerealization ifnotinallsimplicity of sucb
a convergence. As Leroi-Courbanwrites.
!romanimaltomaneverytbingbappenssummarilyasifbrain
were addedto brain, eacbof tbelatestdevelopedformations
involvinganincreasinglysubtlecobesionofalltbeearlierforms
wbicb continue to play tbeir role.
|nverselytbesameautborsbowstbat'allbumanevolutioncon-
vergestoplaceoutsideofmanwbatintberestoftbeanimalworld
correspondstospecihcadaptation,
,,
"wbicbamountstosayingtbat
tbeextemalizationoftbeorgansoftecbnologyisauniquelybuman
pbenomenon.
|t isnot forbiddentoconsidertbe existenceofa

distance between social organs, tbat is, tbe collective tecbnical
meansatman'sdisposal,asaspecib ccbaracteristicofbumanso-
ciety. |tis to tbe extent tbat society is an externality of organs
tbat man can disposeof it by representation and tberefore by
cboice. >otbattoproposetbemodeloftbeorganismforbuman
societies in searcbof more and more organization is essentially
todreamofareturnnoteventoarcbaic,buttoanimal,societies.
Tbereisbardlyneed,tberefore,toinsistnowontbefacttbat
socialorgans,iftbeyarereciprocallypurposeandmeansinaso-
cialwbole,donotexisttbrougboneanotberandtbrougbtbewbole
byvirtueofcoordinatingcausalities.Tbeexternalityofsocialma-
cbinesintbeorganizationisinitselfnodifferentfromtbeexter-
nality of parts in a macbine.
>ocialregulationtendstowardorganicregulationandmimics
itwitboutceasingforalltbattobecomposedmecbanically. |norder
toidentifytbesocialcompositionwitbtbesocialorganismintbe
strictsenseoftbeterm,wesbouldbeabletospeakofasociety's
needsandnormsasonespeaksofanorganism'svitalneedsand
norms,tbatis,unambiguously.Tbevitalneedsandnormsofaliz-
ardorasticklebackintbeirnaturalbabitatareexpressedintbe
veryfacttbattbeseanimalsareverynaturallivingbeings intbis
babitat. butitisenougbtbatoneindividual inanysocietyques-
tiontbeneedsandnormsof tbissocietyandcballengetbem a
sign tbat tbese needs and norms are nottboseof tbe wbole so-
ciety inorderfor usto understandtowbatextentsocialneed
is notimmanent, towbatextenttbesocialnormisnotinternal,
and hnally, towbatextenttbe society, seatof restraineddissent
orlatentantagonisms,is farfromsettingitselfupasawbo|e. |f
tbeindividualposesaquestionabouttbehnalityoftbesociety, is
tbisnottbesigntbattbesocietyisapoorlyunihedsetofmeans,
preciselylackinganendwitbwbicbtbecollectiveactivitypermit-
tedbytbestructurewouldidentify?Tosupporttbiswecouldin-
voketbeanalysesofetbnograpberswboaresensitivetotbediversity
of systems of cultural norms. Lvi->trauss says.
Wetbendiscovertbatno societyisfundamentallygood, but
tbatnoneisabsolutelybad,tbeyalloffer tbeirmembers cer-
tainadvantages, witbtbeprovisotbattbereisinvariablyares-
idue of evil, tbeamountof wbicb seems to remainmore or
less constantand perbaps corresponds to aspecihc inertia in
sociallife resistant to allattempts at organization. '
Cn- e+r s 1 1
O n Or
g
anic Norm s in Man
As fara s bealtbanddisease are concerned, andconsequentlyas
farassettingaccidentsrigbt,correctingdisordersor,asitispop-
ularlysaid,remedyingillsareconcerned,tbereisadilIerencebe-
tweenanorganismandasociety, intbattbetberapistoftbeirills,
intbecaseoftbeorganism,knowsinadvanceandwitboutbesi-
tation,wbatnormalstatetoestablisb,wbile intbecaseof soci-
ety, be does not know.
C. k. Cbesterton,inasmallbookcalledWhat 's Wrong with the
l1or|c, denouncedtbefrequenttendencyofpoliticalwritersand
reformerstodeterminetbestateofsocialillbeforeproposingits
remedies, calling it 'medical error. Tbe quick, brilliant, ironic
refutation of wbat be calls a sopbism rests on tbis axiom.
because,tbougbtberemaybedoubtabouttbewayinwbicb
tbebodybrokedown,tbereisnodoubtatallabouttbesbape
inwbicbitsbouldbebuiltupagain . . . . Vedicalscienceis
contentwitbtbenormalbumanbody andonlyseekstore-
storeit.
|ftbereisnobesitationabouttbehnalityofamedicaltreatment,
tbisisnotso,says Cbesterton,wbenitcomestosocialproblems.
!ortbe determination of tbe ill assumes tbe prior dehnition of
tbe normal social state andtbe searcb for tbis dehnitiondivides
tbosewbo devote tbemselves to it.
Tbesocialcaseisexactlytbeoppositeoftbemedicalcase.We
do notdisagree,likedoctors,abouttbeprecisenature of tbe
illness, wbileagreeingabout tbe nature of bealtb.
|t issocialwelfare tbatisdiscussedinsociety, wbicbmeanstbat
wbatsomeconsideradownrigbtillotbersseekoutasbealtbasa
matter of course' `
Tbereissometbingseriousi ntbisbumor.Tosaytbat'nodoc-
torproposestoproduceanewkindofman,witbanewarrange-
mentofeyesorlimbs,
, ,
istorecognizetbatanorganism'snorm
of life isfurnisbedby tbe organism itself, containedin its exis-
tence.Anditisquitetruetbatnodoctordreamsofpromisingbis
patientsanytbingmoretbanareturntotbestateofvitalsatisfac-
tion from wbicb illness burled tbem down.
butitbappenstbattbereismorebumorinrealitytbaninbu-
morists. ]ust wben Cbesterton was praising doctors foraccept-
ingtbefacttbat tbeorganismprovides tbemwitbtbenormfor
tbeirrestorative activity, certainbiologists began to conceiveof
tbepossibilityofapplyinggeneticstotransformtbenormsoftbe
bumanrace. Tbe hrstlecturesof U.]. Vuller(tbegeneticistfa-
mousforbisexperimentswitbinducedmutations)tobeconcerned
witbcontemporaryman's socialandmoralobligationtointerfere
witb bimself in order togenerally move bimself up to a bigber
intellectuallevel,tbatis,insbort,tovulgarize
geniusbymeansof
eugenics, datefrom l9l0. Ontbewboleitisnotamatterof an
individual desirebutofasocialprogramwbose initialfatewould
baveseemedtoCbestertontbemostperfectconhrmationofbis
paradox.|nOut c the Night, 'Vullerproposedacollectivitywitb-
ON ORGANIC NORMS IN MAN
out classesandwitboutsocial inequalitiesas a social ideal to be
realized, wbere tecbniquesforpreservingseminal |luid and for
artihcialinseminationwouldallowwomen,wbomarationaledu-
cationbadmadeproudtobavesucbanbonor, to bearandraise
tbe cbildrenof menofgenius, of LeninorLarwin. Nowitis
preciselyintbe>ovietUnion, wberetbebookwaswritten,tbat
Vuller's manuscript, senttobigb places wbereitwas tbougbtit
wouldplease,wasjudgedseverelyandtbeRussiangeneticist,wbo
badacted asago-between,fellindisgrace. "Asocialideal based
on atbeoryof bereditylikegenetics, wbicbestablisbes tbe fact
of bumaninequalitybycreatingtecbniquestocorrectit,would
not be welcome in a classless society.
Witboutforgettingtbatgeneticsoffers biologistspreciselytbe
possibilityof conceivingandapplyingaformal biologyandcon-
sequently of transcending life's empirical forms by creating ex-
perimental livingbeingsfollowingotbernorms,wesballagreetbat
upuntilnowabumanorganism'snormisitscoincidencewitbtbe
organism itself, wbile we wait fortbe daywben itwill coincide
witbtbe calculations of a eugenicgeneticist.
|f social norms could be perceived as clearlyas organic norms,
menwouldbemadnottoconformtotbem. Asmenarenotmad
and as tbereare no Wise Ven, socialnormsareto beinvented
andnotobserved.Tbeconceptofwisdomwasaconcepthlledwitb
meaningfor Creekpbilosopbersbecausetbeyconceivedofsoci-
etyas arealityof anorganic typebavinganintrinsicnorm,its
own bealtb, rules ofmeasure, equilibrium and compensation, a
replication and imitation, on tbe buman scale, of tbe universal
lawwbicbmadeacosmos of tbetotalijof beings. Acontempo-
rarybiologist,W.b. Cannon,ecboedtbeassimilationofjuridical
conceptswitbmedical concepts inarcbaic Creektbougbtwben
25
9
beentitledtbeworkinwbicbbeexpoundstbetbeoryoforganic
regulations bomeostasis- , The Wisdom i the Body.40 Tospeakof
tbe wisdom of tbe body leads oneto understand tbattbe living
bodyisinapermanentstateofcontrolledequilibrium,ofdisequi-
librium wbicb is resistedas soon as it begins, of stabilitymain-
tainedagainstdisturbingin|luencesoriginatingwitbout.itmeans,
insbort,tbatorganiclifeisanorderofprecariousandtbreatened
functionswbicb areconstantlyreestablisbedbyasystemofreg-
ulations. |nascribingawisdom totbebody, >tarlingandCannon
repatriatedtopbysiologyaconceptwbicbmedicinebadonceex-
portedtopolitics.YetCannon,inbisturn,couldnotbelpexpand-
ing tbe concept of bomeostasis sotbat begave it tbe power to
clarifysocialpbenomena,entitlingbislastcbapter. 'Relationsof
biological and >ocial Uomeostasis. buttbe analysis of tbese re-
lationsisa tissue of commonplaces ofliberalsociologyandpar-
liamentarypolitics concerning tbealternation inwbicb Cannon
seestbeeffectofa compensationapparatus betweenconserva-
tismandreformism. Asiftbisalternation,farfrombeingtbeef-
fectof an apparatus wbicb is inberent, even intberudimentary
state, toeverysocial structure,werenotinfacttbeexpressionof
tberelativeefhciencyofaregimeinventedtocbannelandsmotber
socialantagonisms,ofapolitical macbineacquiredbymodernso-
cietiesinordertodelay, witbout bnallybeingabletoprevent,tbe
transformation of tbeirinconsistencies into crisis. |n observing
industrialagesocieties itcan beaskedwbetbertbeiractual per-
manent state isnotoneof crisis and wbetber tbis isnotanun-
equivocalsymptomoftbeabsenceoftbeirpowerofself-regulation.
Tberegulationsfor wbicb Cannoninventedtbegeneralterm
homeostasis41 aresimilartotbosewbicbClaudebernardbadunihed
undertbenameof'constantsoftbeinternalenvironment. Tbese
arenormsoforganicfunctioningsucbastberegulationofrespi-
ratorymovements undertbe effectof tberateofcarbonicacid
260
dissolvedintbe blood, tbermoregulationinanimalswitbconstant
temperature, etc. Weknowtodaywbatbernardcould onlysus-
pect, namelytbatotberforms of regulationmustbetaken into
considerationinstudyingorganicstructuresandtbeoriginoftbese
structures. Contemporaryexperimentalembryologybasfoundits
basicproblemsintbefactofmorpbologicalregulationswbicb,in
tbecourseof embryonicdevelopment,conserveorestablisbtbe
integrityof tbespecihcform andextendtbeirorganizingaction
inrepairingcertainmutilations. >otbattbesetofnorms,byvir-
tueofwbicb living beings sbowtbemselvesasformingadistinct
world,canbeclassedasnormsofconstitution,normsofrecon-
stitutionandnormsof functioning.
Tbese differentnormspose tbe same problem for biologists,
namelytbeirrelationtouncommoncaseswbicb,intermsoftbe
normalspecihccbaracteristic,sbowupadistanceoradivergence
of tbis or tbat biological cbaracteristic. beigbt, structure of an
organ, cbemical composition, bebavior, etc. |ftbeindividual or-
ganism is tbe one wbicb, of its own accord, proposes tbe norm
forits restoration,intbe caseofmalformationoraccident,wbat
setsupasnormstbe specibcstructureandfunctionswbichcan-
notbegraspedbytbeindividualsotbertbanastbeyaremanifested?
Tbermoregulation varies from tbe rabbitto tbe stork, from tbe
borsetotbecamel. butbowdoweunderstandtbenormspecu-
liartoeacbspecies,rabbits,forexample,witbouterasingtbesligbt,
fragmentarydissimilaritieswbicbgiveindividualstbeirsingularity?
Tbeconceptofnorma] inbiologyisobjectivelydebnedinterms
oftbefrequencyoftbecbaracteristicsoqualibed. !oragivenspe-
cies, weigbt,beigbt,maturationof instinctsfor agivenageand
sexaretbose wbicb effectivelycbaracterize tbe mostnumerous
groupsdistinctivelyformedbyindividualsofanaturalpopulation
made to appear identical by measurement. |twas Queteletwbo
observedaround1 843 tbattbedistributionofbumanbeigbtscould
26 1
berepresentedby tbe errorlawestablisbedbyCauss,a limiting
formoftbebinomiallaw,andwbodistinguisbedtbetwoconcepts
oftbeCaussianaverageortrueaveragefromtbearitbmeticaver-
age,wbicbwereathrstidentibedintbetbeoryoftbeaverageman.
Tbedistributionoftberesultsofmeasurementon eitberside of
tbeaveragevalueguaranteestbattbeCaussianaverageistbetrue
average. Tbegreatertbe divergences tberarertbey are.
|nourEssay (|artTwo,11) wetriedtopreserveintbeconcept
ofnormameaninganalogoustotbatoftbeconceptoftypewbicb
Queteletbadsuperimposedonbistbeoryoftbeaveragemanfol-
lowingtbediscoveryoftbetrueaverage. |tisananalogousmean-
ing,tbatis,similarinfunctionbutdifferentinfoundation.Quetelet
deb ned tbe regularity expressed by tbe average, by tbe greatest
statistical frequency, as tbeeectoflivingbeings' submissionto
laws of divine origin. Webad tried to sbowtbat tbe frequency
canbeexplainedintermsofregulationsofanordercompletely
differentfromconformitytosupernatural legislations.Webadin-
terpretedfrequencyastbeactualorvirtualcriterionoftbevi-
talityofanadaptivesolution.Webavetobelievetbatourattempt
misseditsgoal since it bas been criticizedforobscurityandfor
drawingtbeunwarrantedconclusiontbattbegreatestfrequency
equalstbebestadaptation. |nfacttbereisadaptationandadap-
tation,andtbesenseinwbicbitisunderstoodintbeobjections
madetoourworkisnottbesensewebadgivenit.Tbereisone
formofadaptationwbicbisspecializationforagiventaskinasta-
bleenvironment,butwbicbistbreatenedbyanyaccidentwbicb
modihestbisenvironment.Andtbereisanotberformofadapta-
tionwbicbsignihesindependencefromtbeconstraints of a sta-
bleenvironmentandconsequentlytbeabilitytoovercometbe
difhculties oflivingwbicbresultfrom a cbange intbe environ-
ment.Now,webavedehnedaspecies'normalityintermsofacer-
taintendencytowardvariety,'akindofinsuranceagainstexcessive
262
specializationwitboutreversibility, bencewitbout|lexibility,wbicb
is. . . asuccessfuladaptation. |nadaptationperfectorcompleted
meanstbebeginningoftbeendofspecies.Attbattimewewere
inspiredbyanarticleoftbebiologistAlbert\andel,wbolaterde-
velopedtbesameideasinbisbook,L'homme et l'evolution. 44 Vay
we now be allowed to resume ouranalysis.
Wbentbenormalisdehnedintermsoftbemostfrequent,a
considerableobstaHeiscreatedtounderstandingtbe biological
signihcanceof tboseanomalies wbicbgeneticistsbavegiven tbe
nameofmutations. |ndeed,totbeextenttowbicbamutationin
tbeplantoranimalworldcanbetbeoriginofanewspecies,we
canseeonenormarisefromadivergencefromanotbernorm.Tbe
normistbeform of divergencemaintainedby natural selection.
|tiswbatdestructionanddeatbconcedeatrandom.butweknow
welltbatmutationsaremore oftenrestrictivetban constructive,
often superhcial wben tbey are lasting, andwben tbey are con-
siderable, tbey involve fragility, a decreaseinorganicresistance.
>otbatoneacknowledgestbepowerofmutationstodiversi[spe-
cies intovarietiesratbertbanto explain tbeoriginof species.
>trictlyspeaking,amutationisttbeoryoftbeoriginofspecies
candehnetbenormalonlyastbetemporarilyviable.butbycon-
sideringtbelivingonlyastbedeadwitbarespite,weignoretbe
adaptive orientation of tbewbole oflivingbeings consideredin
tbecontinuityoflife,andweunderestimatetbisaspectofevolu-
tionwbicbisvariationofmodesoflifefor tbeoccupationofall
vacantplaces. `Tbere istbenonemeaningofadaptationwbicb
allowsonetodistinguisb,atagivenmomentina species andits
mutants,betweenobsoleteandprogressivelivingbeings.Animal-
ity is a form of life cbaracterized bymobilityandpredation. |n
tbisregardvisionisafunctionwbicbmigbtnotbecalleduseless
formobilityinligbt.Ablindandcave-dwellinganimalspeciescan
besaidtobeadaptedtotbedarkandwecanimagineitsappear-
ance by means ofmutation, startingfromasigbtedspecies, and
its maintenancebyencounteringandoccupyinganenvironment
wbicb,ifnotadequate,isatleastnotcontra-indicated.Nonetbe-
less,blindnessisconsideredananomaly,notintbesensetbatitis
araritybutintbesensetbatitmeansregressionfortbelivingbeings
concerned, a placing aside in a dead end.
|tseemstoustbatoneoftbesignsoftbedifhcultyinexplain-
ingtbespecib cnorminbiologyintermsofasingleencounterof
independentcausal series,onebiological,tbeotbergeograpbical,
istbeappearance,in1954, ofLerner'sconceptofgeneticbomeo-
stasis inpopulationgenetics. Tbestudyoftbearrangementsof
genesandtbeappearanceofmutantgenesinindividualsinnatu-
ralandexperimentalpopulations,combinedwitbtbestudyoftbe
effectsofnaturalselection,baveledtotbeconclusiontbattbese-
lectiveeffect of agene or of acertainarrangement of genesis
notconstant,tbatitundoubtedlydependsonenvironmenta|con-
ditionsbutalsoonakindofpressureexertedonany oneindivid-
ualbytbegenetictotalityrepresentedbytbepopulation.Lvenin
tbecaseofbumandiseases,forexampleCooley'sanemia,wbicb
is common in tbe Vediterranean, particularly in >icily and >ar-
dinia,aselectivesuperiorityof beterozygoteindividualsoverbo-
mozygotes bas been observed. |n animalson breeding farms tbis
superioritycanbemeasuredexperimentally. Tbis coincideswitb
tbe old observations of breeders concerningtbe invigorationof
breeding lines bycrossbreeding. Ueterozygotes aremorefertile.
|ntbecaseofaletbalmutantgene,abeterozygoteenjoysaselec-
tiveadvantageinrelationnotonlytotbemutantbomozygotebut
alsototbenormalbomozygote wbencetbeconceptofgenetic
bomeostasis. Totbeextenttowbicbtbesurvivalofapopulation
isfavoredbytbefrequencyofbeterozygotes,tbeproportionalre-
lationbetweenfertilityandbeterozygosiscanbeconsideredareg-
ulation.Accordingto]. b. >. Ualdanetbesameistrueforaspecies'
resistance tocertainparasites.Abiocbemical mutationcanobtain
agreatercapacityforresistancefortbemutant.Tbeindividualbio-
cbemical differenceattbebeartofaspeciesmakesitmorehtto
survive,attbecostofalterationswbicbmorpbologicallyandpbysi-
ologicallyexpresstbeeffectsofnaturalselection.Unlikebuman-
itywbicb,accordingtoVarx, poses onlyproblemswbicbitcan
solve,lifemultipliesbeforebandtbesolutionstoproblemsofad-
aptation wbicb couldpresenttbemselves.'
To summarize,tbereadingandre|lectingwbicbwebavebeen
abletodosincetbel 9+1publicationofourEssay bavenotledus
toputinquestiontbeinterpretationproposedtbenfor tbe bio-
logicalfoundationof tbeoriginalconcepts of biometry.
|t doesnot seemto us tbatwemustprofoundlymodilyour anal-
ysisoftberelationsbetweentbedeterminationofstatisticalnorms
andtbeevaluationoftbenonnalityorabnormalityof tbis ortbat
individualdivergence.|ntbeEssay wereliedontbestudiesofAndr
VayerandUenri Laugier. Amongtbenumerousarticlespublisbed
since on tbe same subject, two bave claimed our attention.
Tbe brstbelongs to A. C. |vy. 'WbatisNormal or Normal-
ity?( l 9++).Tbeautbordistinguisbesfourmeaningsoftbecon-
ceptofnormal. ( l ) coincidence betweenan organicfactand an
idealwbicbdecidestbelowerorupperlimitofcertaindemands,
(2) tbepresenceinanindividualofcbaracteristics (structure,func-
tion,cbemicalcomposition)wbosemeasureisconventionallyde-
terminedbytbecentralvalueof agroupwbicbisbomogeneous
intermsofage,sex,etc. , ( 1) anindividual'ssituationintermsof
tbe average for eacbcbaracteristicconsidered, wben tbe distri-
butioncurvebasbeenconstructed,tbedivergencetypecalculated
andtbenumberof divergencetypes determined, (+)tbeaware-
ness of tbe absence of bandicaps.
Tbeuseoftbeconcept normaldemandstbatonespecifybrst
tbe meaning by wbicb oneunderstands it. !orbis part, tbe au-
tborconsidersonly numbers 1 and 4, subordinatingtbelatterto
tbeformer. Ueapplies bimself tosbowingbowdesirableitis to
establisbtbetypicaldeviationofmeasurementvaluesofstructure,
functionsorbiocbemicalcomponents inalarge numberofsub-
jects,especiallywbentberesultsdeviatestrongly,andtoconsider
asnormaltbevaluesrepresentedby68. 26% ofanexaminedpop-
ulation, tbat is, tbe valuescorrespondingto tbe average p|us or
minusastandarddeviation.|tistbesubjectswbosevaluesfallout-
side tbe68% wbo pose difb cultevaluation problems intermsof
tbeirrelationtotbenorm.!orexample.tbetemperatureof10,000
students,wboareaskedtosaywbetbertbeyfeelfeverisbornot,
istaken, tbedistributionoftbetemperaturesisconstructed,and
foreacbgroupwitbtbesametemperaturetbecorrelationbetween
tbe number of individuals and tbe number of subjects wbo say
tbeyarefeverisb,iscalculated.Tbeclosertbecorrelationisto1 ,
tbegreatertbecbancesaretbattbesubject,becauseofaninfec-
tion, isinapatbologicalstate. Outof 50 subjectswitbatemper-
atureof 100 !,tbereisonlya l+% cbanceforanormalsubject
from tbesubjectivepointof view(i. e. , onewbodidnotfeelfe-
verisb)tobea normal subjectfrom tbe bacteriological pointof
view.
Tbeinterestof|vy'sstudylieslessintbeinformationfromclas-
sicalstatisticstbanintbesimplicitywitbwbicbtbeautboracknowl-
edges tbe difhcultiesof tbecoincidenceofconceptssucbastbe
pbysiologicalnormalandtbestatisticalnormal. Tbestateofpbys-
iological plenitude ('tbe bealtbful condition in |vy's work]) is
debnedasastateofequilibriumoffunctionstbataresointegrated
tbat tbey gain fortbe subject a large measure of security, a ca-
pacityforresistanceinacriticalsituationorasituationofforce.
Tbenormal state of a functionistbatofnotinterfering witb
266
ON ORGANI C NORMS IN MAN
otbers. butcanitnotbeobjectedtotbesepropositionstbatmost
functions,becauseof tbeirintegration,dointerfere. |fwemust
understandtbat a function isnormalinsofar as it does not lead
anotberto abnormality, basn'ttbe questionbeensbifted? |nany
casetbecomparisonoftbesepbysiologicalconceptsandtbecon-
ceptofnormstatisticallydehned tbestateof68% ofsubjectsin
abomegeneousgroup sbowsuptbeinabilityoftbestatistically
dehnednormtoresolveaconcreteproblemofpatbology.Tbefact
tbat an oldman exbibitsfunctions includedin tbe 68% corres-
pondingtobisageisnotsufhcienttoqualifybimasnormaltotbe
extenttbattbepbysiologicalnormalisdehnedintermsofamar-
ginofsecurityintbeexerciseoffunctions.Agingisexpressed,in
elIect,bytbereductionoftbis margin. !inallyananalysissucbas
|vy's,startingfromotber examples, wantstoconhrmtbeinade-
quacy,oftenrecognizedbeforebim,oftbestatisticalpointofview
eacb time itmust be decided as to wbat is normal or not for a
given individual.
Tbenecessityto rectifytbeconceptof tbestatisticalnormal
and to make it llexible inresponse to tbe pbysiologist's experi-
encebasedontbevariabilityoffunctionsisalsobrougbttoligbt
inanarticleof1 947 by]obnA.Ryle,TbeVeaningofNormal.
, ,
"
Tbeautbor,aprofessorof socialmedicineatOxford,isinterested
hrstinestablisbingtbatcertainindividualdivergences,inrelation
topbysiologicalnorms,are not, for alltbat,patbological indica-
tors. |tisnormalforpbysiologicalvariabilityto exist, itisneces-
saryforadaptationandbencesurvival.Tbeautborexamined1 00
studentsingoodbealtb,freeofdyspepsia,inwbombetookmea-
surementsofgastricacidity. Ueascertainedtbat10% sbowedwbat
couldbeconsideredpatbologicalbypercblorbydria sucb asisob-
servedintbe case of duodenalulcer,andtbat+%sbowedtotal
acblorbydria,asymptomconsidereduntiltbenasindicativeofpro-
gressiveperniciousanemia.Tbeautbortbinkstbatallmeasurable
pbysiological activities sbow tbemselves susceptibleof ananalo-
gousvariability,tbattbeycanberepresentedbytbeCaussiancurve
andtbat,fortbeneedsofmedicine,tbenormalmustbeincluded
between tbe limits determined by a standard deviation on botb
sidesof tbe median. buttbere is no cleardividinglinebetween
innatevariationscompatiblewitbbealtb,andacquiredvariations
wbicbaretbesymptomsofa disease. |freallynecessary, onecan
tbinktbatanextremepbysiologicaldivergenceintermsoftbeav-
erageconstitutes orcontributes to constitutinga predisposition
to tbis or tbat patbological accident.
]obnA.Ryleliststbemedicalactivities,forwbicbtbeconcept
of'normalclearlyunderstoodcorrespondstoaneed,asfollows.
(1 ) dehnitionof tbepatbological,(2) deb nitionoftbefunctional
levels to aim for intreatmentor reeducation, ( 3) tbe cboice of
personnelemployedinindustry,(4
) trackingdownpredispositions
to disease.
Letusnote,foritisnotunimportant,tbattbelasttbreeneeds
oftbislistconcerncriteriaofexpertise,capacity, incapacity,mor-
tality risk.
!inallyR yledistinguisbestwo kinds of variationsrelativeto
tbe norm, witb regard to wbicb itmaybe tbat oneisto decide
abnormalityinviewofcertainresolutionstobetakenofaprac-
tical order. variations affectingtbesameindividualaccordingto
time, variations, at agiven moment, from one individual to an-
otberintbe species. Tbese two kinds of variations are essential
forsurvival.Adaptabilitydependsonvariability. buttbestudyof
adaptabilitymustalwaysbecircumstantial,itisnotenougbtopro-
ceed to laboratory measurementsandtests,tbepbysical andso-
cialenvironment,diet,modeandconditionsofwork,tbeeconomic
situationandeducationofdifferentclassesmust also bestudied,
forastbenormalisconsideredastbeindicatorofahtnessoran
adaptability, we must always askourselvestowbatandforwbat
268
mustwe determineadaptabilityandhtness. !orexample.tbeau-
tborreportstberesultsofaninvestigationintotbyroidenlargement
in l l to l year olds inareas wbere tbe amountofiodine intbe
drinkingwaterbasbeenpreciselymeasured.|ntbiscasetbenor-
malistbetbyroidwbicbisexternallyinconspicuous.Tbeconspic-
uoustbyroidseemsto indicatea specihc mineral dehciency. but
asfewcbildrenwitbaconspicuoustbyroidendupwitbgoiter,it
canbeclaimedtbataclinicallydiscerniblebyperplasiaexpresses
adegreeofadvancedadaptationratbertbantbehrststageofdis-
ease. >incetbetbyroidisalwayssmallerin |celanders, andsince,
ontbeotberband,tbereareareasinCbinawbere60% oftbein-
babitantsbavegoiters,itseemstbatwecanspeakofnationalstan-
dardsofnormality |nsbort,inordertodehnetbenormal,wemust
refertoconceptsofequilibriumandadaptability, andbearinmind
tbe external environment, and tbe work wbicbtbeorganism or
its parts must accomplisb.
Tbestudywebavejustsummarizedisinteresting,witboutbeing
metbodologicallyintolerant,andendsbyconcludingtbattbepre-
occupationsofexpertiseandevaluationprevailovertboseofmea-
surement in tbe strict senseof tbe word.
|n dealing witb buman norms we acknowledge tbat tbey are
determinedasanorganism'spossibilitiesforactioninasocialsit-
uationratbertbanasanorganism'sfunctionsenvisagedasamecb-
anism coupled witb tbe pbysical environment. Tbe form and
functionsoftbebumanbodyaretbeexpressionnotonlyofcon-
ditionsimposedon life by tbeenvironmentbutalsoof socially
adoptedmodesoflivingintbeenvironment.|nourEssay wetook
intoaccountobservationswbicballowedustoconsideraninter-
dependence betweennatureandculturetobeprobableindeter-
miningbumanorganicnorms,fromtbefactoftbepsycbosomatic
relation.`At tbe timeourconclusionsmigbtbave seemed rasb.
Today itseems toustbattbedevelopmentofstudiesinpsycbo-
somatic and psycbosocial medicine, particularly in Anglo->axon
countries,wouldtendto conhrmtbem. Awell-knownspecialist
in social psycbology, Otto klineberg, in a study on tensions re-
latedtointernationalunderstanding,5 1 baspointedouttbepsycbo-
somatic and psycbosocial causes of varieties of reactions and
disturbancesinvolvingapparentlylastingmodihcationsoforganic
constants. Cbinese, Uindusand !ilipinosexbibitanaverage sys-
tolicpressure 15 to 20 pointslowertbanAmericans' . buttbeav-
eragesystolicbloodpressureofAmericanswbobavepassedseveral
yearsinCbinafellduringtbatperiodfrom1 1 8 to109. >imilarlyit
couldbenotedtbatduringtbeperiod1 920-1 930 bypertensionin
Cbinawasveryrare.Wbilehndingit'simplisticintbeextreme
klineberg cites tberemarkof an American doctor, made about
1929:
|fwestayi nCbinalongenougbwelearntoaccepttbingsand
ourbloodpressurefalls. CbineseinAmericalearnto protest
and to not accept and tbeir bloodpressure mounts.
Toassume tbat VaoTse-Tung bascbangedalltbatisnot being
ironic, but simply applying tbe same metbod of interpreting
psycbosocial pbenomena to otber political and social data.
Tbeconceptofadaptationandtbatofpsycbosomaticrelation
to wbicb its analysis leads, in tbe caseofman, canbetaken up
againandreworked,sotospeak,asaIunctionoftbeoriesofpa-
tbologywbicbdifferastotbeirbasicobservations,butwbicbcon-
verge inspirit. Relatingpbysiological norms inman to sbowup
culturalnorms,isnaturallyextendedbytbestudyof speci hcally
bumanpatbogenicsituations. |nman,unlikeinlaboratoryanimals,
tbepatbogenicstimulioragentsareneverreceivedbytbeorgan-
ismasbrutepbysical facts,butarelivedby tbeconsciousnessas
signs of tasks or tests.
2
7
0
Uans>elye almostattbesametimeasReillyin!rance was
one of tbe hrst to tackle tbe study of nonspecihc patbological
syndromes,cbaracteristicreactionsandbebaviorsineverydisease
consideredatitsonset,fromtbegeneralfactof'feelingsick.
,,
`
Anonspecihcaggression(i. e. abrusquestimulation)provokedby
anystimuluswbatsoever foreignbody, purihedbormone, trau-
matism, pain, repeated emotion, imposed fatigue, etc. tri_ers
off hrstanalarmreaction,alsononspecihc,consistingessentially
intbewbolesaleexcitationoftbesympatbeticnervewbicbisac-
companiedbyanadrenalinandnoradrenalin secretion. |nsbort
tbealarmputs tbeorganismin a state of emergency, a state of
indehniteparrying. Tbis alarm reaction is followed by eitbera
specihcstateof resistance, as if tbe organism badidentib edtbe
nature oftbeaggression,wasadaptingits responsetotbeattack
andwasreducingitsinitialsusceptibilitytotbeoutrage,or,bya
state of exbaustion wben tbe intensity and ceaselessness of tbe
aggressionexceed reactioncapacities.Tbeseare>elye'stbreemo-
mentsoftbegeneraladaptationsyndrome.Adaptationistbuscon-
sideredastbepbysiologicalfunctionparexcellence.Wepropose
todehneitasorganicimpatiencewitbtbeindiscreetinterventions
orprovocationsoftbeenvironment,beitcosmic(actionofpbysico-
cbemical agents) or buman (emotions). |f by pbysiology we un-
derstandtbescienceoftbefunctionsofnormalman,itmustbe
recognizedtbattbissciencerestsontbepostulatetbatnormalman
istbemanofnature.Asonepbysiologist,bacq,wrote.Tranquility,
laziness,psycbicindifferencearedecisivetrumpsfortbemainte-
nanceofnormalpbysiology.
, ,
`butperbapsbumanpbysiologyis
alwaysmoreor less appliedpbysiology, pbysiology of work,of
sport,ofleisure,oflifeatbigbaltitudes,etc. , tbatis,tbebiologi-
cal study of man incultural situations wbicb generate varied
aggressions. `|ntbissensewewouldhndin>elye'stbeoriescon-
brmationoftbefacttbatnormsarerecognizedbytbeirdivergences.
2
7
I
Undertbenameof'adaptationdiseasesmustbeunderstood
allkindsofdisordersoftbefunctionofresistancetodisturbances,
diseasesoftbefunctionofresistancetobarm. bytbisletusun-
derstandreactionswbicbgobeyondtbeirgoal,wbicbrunontbeir
impetus andpersevere until tbe aggression bas stopped. Now is
tbe time tosay witbF Lagognet.
Tbesickpersoncreates diseasebytbeveryexcessof bisde-
fenceandbytbeimportanceofareactionwbicbprotectsless
tbanitexbaustsandupsets.Tberemedieswbicbinbibitorsta-
bilizetakeprecedenceoveralltbosewbicbstimulate,encbance,
orsustain.``
|tisnotwitbinourcompetencetodecidewbetber>elye'sobser-
vationsandtboseofReillyandbisscboolareidenticalandwbetber
tbebumoralmecbanismsinvokedbyoneandtbeneurovegetative
mecbanismsinvokedbytbeotbersarecomplementaryornot.`We
consideronlytbe convergence of tbese tbeses on tbefollowing
point. tbe predominance of tbe notion ofpatbogenic syndrome
overtbatofpatbogenicagent,tbesubordinationoftbenotionof
lesion to tbat of tbe disturbance of functions. |n a famous lec-
ture,contemporarywitbtbeearlyinvestigationsofReillyand>elye,
P Abramidrewattentiontotbenumberandimportanceoffunc-
tionaldisturbances,wbicb,fromtbepointofviewoftbeclinical
symptomatologyofidenticallesions,aresometimescapableofdi-
versifying,andaboveallintbelongrun,sometimescapableofgiv-
ingbirtb toorganic lesions. `'
by now, weare far from tbe wisdom oftbebody. |n effect,
onecouldsuspectasmucbbycomparingadaptationdiseaseswitb
all tbe pbenomena of anapbylaxia, allergy, tbat is to say, all tbe
organism'spbenomenaofbyperreactivityagainstanaggressionto
wbicbitissensitized.|ntbiscasediseaseconsistsintbeimmoder-
2
7
2
acyoftbeorganicresponse,intbeoutburstandstubbornnessof
tbedefense,asiftbeorganismaimedbadly,calculatedbadly.Tbe
term'errorcamenaturallytotbemindsofpatbologiststodes-
ignatea disturbance wboseoriginis to besougbtintbe pbysio-
logicalfunctionitselfandnotintbeexternalagent.|nidentifying
bistamine,>irUenryLalebadconsidereditasaproductof'or-
ganic autopbarmacology. ` !rom tben on, can a pbysiological
pbenomenonwbicbendsupinwbatbacqcalls'Tbeveritablesui-
cideoftbeorganismbymeansoftoxicsubstanceswbicbitstocks
inits own tissues, be calledanytbing otbertban error?`
2
7 3
CHAPTER | | |
A New C once
p
t in Patho l o
g y
: Error
|nourEssay wecomparedtbeontologicalconceptionofdisease,
inwbicbdiseaseisportrayedastbequalitativeoppositeofbealtb,
witbtbepositivistconception,wbicbderivesitquantitativelyfrom
tbenormal state. Wben diseaseisconsideredasan evil, tberapy
isgivenforarevalorization,wbendiseaseisconsideredasdehciency
or excess, tberapy consists in compensation. Against bernard's
conceptionof disease we settbe existence of illnesses sucb as
alkaptonuria,wbosesymptomcaninnowaybederivedfromtbe
normalstateandwboseprocess tbeincompletemetabolismof
tyrosine bearsnoquantitativerelationtotbenormalprocess.`"
|tmustbeacknowledgedtodaytbateventbenourargumentcould
bavebeenfurtbersolidibedbybeingmorebroadlybuttressedwitb
examples, by considering albinism and cystinuria.
>incel909tbesemetabolic diseases, becausetbeyblockreac-
tionsatanintermediarystage,bavebeengiventbestrikingname
of'inbomerrorsofmetabolism,
,,60
atermcoinedby>irArcbibald
Carrod. Uereditarybiocbemicaldisturbances,nevertbelesstbese
geneticdiseasescannotmanifesttbemselvesasearlyasbirtb,but
ratberintbecourseof timeandsbouldtbeoccasionpresentit-
self, as for example,intbebumanorganism's lackof a diastase
(glucose-6-pbospbate-debydrogenase)wbicbgivesrisetonodis-
2
7
5
turbanceaslongastbesubjectdoes notintroduce beans into bis
dietortake quinineto combatmalaria. !orhftyyearsmedicine
badrecognizedonlybalfadozenoftbesediseases,andtbeycould
beconsideredrarities. Tbis explainswbytbe conceptofinborn
metabolicerrorwas nota common conceptinpatbologyattbe
timeweundertookourmedicalstudies.Todaybereditarybiocbemi-
cal diseases numberabout one bundred. Tbe identib cationand
treatmentofsomeoftbeparticularlydistressingonessucbaspben-
ylketonuriaorpbenylpyruvicimbecilitybavegivengroundsforgreat
bopesinextendingtbegeneticexplanationofdiseases. Tbeetiol-
ogyofsporadicorendemicdiseasessucbasgoiterisbeingrevised
in tbe ligbt of researcb on biocbemical anomalies of a genetic
nature. ' >owecanimaginetbat,wbiletbeconceptofinbornerror
ofmetabolismbas not bcomeapopularconcept,strictlyspeak-
ing, itisnevertbeless acommonone today. Tbetermsanomaly,
lesion, borrowedfromtbelanguage ofmorpbologicalpatbology,
bavebeenimportedintotbedomainofbiocbemicalpbenomena.
Attbeoutset,tbeconceptofbereditapbiocbemicalerrorrested
ontbeingenuityofametapbor, today itisbasedontbesolidity
ofananalogy |nsofarastbefundamentalconceptsoftbebiocbem-
istryofaminoacids andmacromoleculesareconceptsborrowed
frominformationtbeory, sucbascodeormessage,andinsofaras
tbestructuresoftbematteroflifearelinearstructures,tbeneg-
ativeoforderisinversion,tbenegativeofsequenceisconfusion,
andtbesubstitutionofonearrangementforanotberiserror. Uealtb
isgeneticandenzymaticcorrection.Tobesickistobavebeenmade
false,to befalse, notintbe senseof afalsebanknoteora false
friend,butintbesenseofa'falsefoldi . e. , wrinkle.oexpl] or
afalserbyme. >inceenzymesaretbemediatorstbrougbwbicbtbe
genes direct intracellularprotein syntbeses, and since tbe infor-
mationnecessaryfor tbis function of direction and surveillance
isinscribedintbeLNAmoleculesattbecbromosomelevel,tbis
2
7
6
A NEW CONCEPT IN PATHOLOGY: ERROR
informationmustbe transmittedas a message from tbe nucleus
to tbe cytoplasm andmustbeinterpretedtbere, sotbattbe se-
quenceofaminoacidsconstitutingtbeproteintobesyntbesized
isreproduced, recopied. butwbatevertbemode,tbereisno in-
terpretationwbicbdoesnotinvolveapossiblemistake.Tbesub-
stitutionofoneaminoacidforanotbercreatesdisordertbrougb
misunderstandingtbecommand.!orexample,intbecaseofsiclle-
cell anemia, tbat is, red blood cells sbaped likea sickle because
ofretractionfollowingaloweringofoxygenpressure,tbebemo-
globinisabnormalbecauseoftbesubstitutionofvalineforglu-
tamic acidin tbeglobulin's amino-acid cbain.
Tbeintroductionof tbeconceptoferrorintopatbologyisa
factofgreat importance as mucb in terms of tbe cbange it re-
vealsinwbatitbringstobearinman's attitudetowarddisease,as
intermsoftbenewstatuswbicbissupposedlyestablisbedintbe
relationsbipbetweenknowledge andits object. |t would bevery
temptingtodenounceanidentihcationoftbougbtandnature,to
protesttbattbestepsoftbougbtareascribedtonature,tbaterror
is cbaracteristic ofjudgment, tbat nature can be a witness, but
neverajudge,etc.Apparentlyeverytbingbappens,ineffect,asif
tbebiocbemistandgeneticistattributedtbeirknowledgeascbem-
istandgeneticisttotbeelementsoftbebereditarypatrimony, as
if enzymesweresupposedtoknowormustknowtbe reactions
accordingtowbicbcbemistryanalyzestbeiractionandcould,in
certaininstancesoratcertaintimes,ignoreoneof tbemormis-
readtbeterms.butitmustnotbeforgottentbatinformationtbe-
orycannotbebrokendown,andtbatitconcernsknowledgeitself
aswellasitsobjects,matterorlife. |ntbissensetoknowistobe
informed,tolearntodeciberordecode.Tbereistbennodilfer-
encebetweentbe erroroflifeand tbe erroroftbougbt,between
tbeerrorsof informingandinformedinformation.Tbehrstfur-
nisbestbe keytotbe second. !rom tbe pbilosopbicalpointofview
2
77
it would bea questionof a new kind of Aristotelianism,ontbe
condition,ofcourse, tbatAristotelianpsycbobiologyandtbemod-
ern tecbnology of transmission not be confused.
|ncertainrespectstbisnotionoferrori ntbebiocbemicalcom-
positionoftbisortbatconstituentofanorganismisalsoAristo-
telian.AccordingtoAristotle,amonsterisanerrorofnaturewbicb
wasmistakenaboutmatter. |fincontemporarymolecularpatbol-
ogy, errorgenerates formal llaws, bereditary biocbemical errors
arealwaysconsideredasamicroanomaly,amicromonstrosity. And
justas a certain number of congenital morpbological anomalies
areinterpretedasahxationoftbeembryoatastageofdevelop-
mentwbicbsbouldnormallybepassedtbrougb,soacertainnum-
berofmetabolicerrorsarelikeaninterruptionorsuspensionof
a series of cbemical reactions.
|nsucbaconceptionofdiseasetbebarmistrulyradical. |fit
manifests itselfattbelevelof tbeorganismtakenasawbole,at
gripswitbanenvironment,itremainsattbeveryrootsoftbeor-
ganization,attbelevelwbereitisstillonlylinearstructure,wbere
nottbedomain buttbeorderof tbeliving beingbegins. Lisease
isnotafalltbatonebas, anattacktowbicbonesuccumbs,but
anoriginaldawinmacromolecularform.|f,inprinciple,organi-
zationisakindoflanguage,tbegeneticallydetermineddiseaseis
nolongeramiscbievouscursebutamisunderstanding.Tbereare
badreadingsofa bemoglobinjustastberearebadreadingsof a
manuscript. but bere we are dealing witb a word wbicb comes
fromnomoutb,witbawritingwbicbcomesfromnoband.Tbere
istbennoillwillbebindtbeillfate.Tobesickistobebad,notas
abadboybutas poorland. Liseaseisnolongerrelatedtoindi-
vidualresponsibility,nomoreimprudence,nomoreexcesstoin-
criminate, noteven collective responsibility as in tbe case of
epidemics.Aslivingbeings,wearetbeelIectoftbeverylawsof
tbemultiplicationoflife,assickmenwearetbeeffectofuniver-
salmixing,loveandcbance.Alltbismakesusunique,asbasoften
been writtentoconsoleusforbavingbeenmadefrom balls drawn
bylotintbeumofVendelianberedity. Unique,certainly,butsome-
timesalsobadlyturnedout. |tisnottooseriousifitisonlyamat-
teroferrorintbemetabolismoffructosebecauseoftbelackof
bepatic aldolase. |t ismore serious ifitisaquestionof bemo-
pbilia,arisingfromtbelackofsyntbesisofaglobulin.Andwbat
istobe said, if notinadequately, ifweare dealingwitbanerror
intbemetabolismoftryptopbanewbicb,accordingto ]. Lejeune,
determines Vongolian trisomy?
Tbetermerrormobilizestbeaffectivitylesstbantbetermsdis-
easeorill,wronglynevertbeless, if itistruetbaterroris,attbe
outset,miscarriage.Tbisiswbytbeintroductionoftbeoreticalil-
lusionintotbevocabularyofpatbologyletscertainpeoplebope,
perbaps, for progresstowardrationalityinnegativevital values.
|nfactwben tbeeradicationoferroris obtained, it is irrevers-
ible,wbile tbe cure for a diseaseis sometimes tbe open doorto
anotber, bencetbeparadoxof 'diseaseswbicbaredangerous to
cure.
, ,
`
Nevertbelessitcanbemaintainedtbattbenotionofinnateor-
ganicerrorsisanytbingbutreassuring. |ttakesagreatdealofclar-
ity coupledwitbgreatcourage not topreferanideaof disease
wberesomefeelingof individualculpabilitycanstillhndaplace
inanexplanationofdiseasewbicbpulverizesandscattersitscau-
salityintbefamilialgenome,inalegacywbicbtbelegateecannot
refusesincelegacyandlegateearebutone.butintbeenditmust
beadmittedtbattbenotionoferror,liketbeconceptofpatbol-
ogy, is polysemic. |fit consists, attbe outset, ina confusion of
formula,afalsetakenfortbetrutb,itisrecognizedassucbattbe
conclusionofresearcbwbicbbasbeenstimulatedbytbedifhculty
ofliving,orbypain,orbysomeone'sdeatb.|nrelationtotbede-
nial of deatb, pain, difhcultyinliving, tbatis,tomedicine'sri-
2
79
sons d'etre, tbeerrorofenzymatic reading isexperiencedbytbe
manwbo suffers from itas a faultof conduct without tbe fault
of tbe conductor. |nsbort,tbeuseof tbetermdesignatingtbe
logicalfaultdoesnotsucceedintotallyexorcizingfrommedical
semanticstbetracesofanguisbfeltwitbtbeideawbicbwemust
countwitb anoriginal abnormality.
Lessreassuringstillis tbe ideatbatitisappropriatetodevelop
amedicalcounterparttobereditaryerrorswbentbisideaisformed
as an idea and not as a desire. bydehnitiona treatment cannot
putanendto wbat isnot tbe consequenceof anaccident. Ue-
redityistbemodernnameof substance. Wecanimaginetbatit
ispossibletoneutralizetbeeffectsofanerrorofmetabolismby
constantlymrnisbingtbeorganismwitbtbereactionproductwbicb
isindispensabletotbeexerciseoftbatfunction,of wbicbanin-
completecbainofreactionsdeprivesit. Andtbisiswbatis suc-
cessfullydone in tbe caseof pbenylpyruvicoligopbrenia. butto
compensateanorganism'sdehcienciesforlifeonlyperpetuatesa
solutionofdistress.Tberealsolutiontoberesyisextirpation.Con-
sequentlywbynotdreamofbuntingforbeterodoxgenes,ofage-
neticinquisition?Andwbilewaiting,wbynotdeprivesuspectsires
of tbelibertyof sowing broadcast?Weknowtbattbesedreams
are notonly dreams forsomebiologists of very different pbilo-
sopbicalpersuasion,ifwemaycallittbat.butindreamingtbese
dreams,weenteranotberworld,borderingontbebravestofAldous
Uuxley'sfrom wbicbsickindividuals,tbeirparticulardiseasesand
tbeirdoctorsbavebeeneliminated.Tbelifeofanaturalpopula-
tion isportrayedasa lotto sackandtbefunctionaries delegated
bytbelife sciencesbavetbetaskofverifyingtheregularityofits
numbers before tbe players are allowed to draw tbemfrom tbe
sackto hll tbeir cards. At tbe beginning of tbis dreamwe bave
tbegenerousambitiontospareinnocentandimpotentlivingbeings
tbeatrociousburdenofproducingerrorsoflife. Attbeendtbere
2 80
A NEW CONCEPT IN PATHOLOGY : ERROR
aretbegene police, clad intbegeneticists'science. !oralltbat it
sbouldnot beconcludedtbat one is obligedtorespectagenetic
'laisser-faire,laisser-passer,butonlyobligedtoremindmedical
consciousnesstbattodreamofabsoluteremediesisoftentodream
of remedies wbicb are worse tban tbe ill.
|fdiseasescausedbyinnatecbemicalmalformationsarenumer-
ousas to tbeirvariety, none iswidespread. |fitwere otberwise,
tbeconceptoftbewisdomoftbe bodywouldseemveryirrele-
vant,towbicbonemayanswertbattbeerrorsoforganizationdo
notcontradicttbewisdomoforganisms,tbatis, tberesultsofor-
ganization.Wbatwas once true of hnalityis true today of orga-
nization. Against hnality onebasalways invokedlife'sfailures,tbe
disbarmonyoforganisms,ortberivalryoflivingspecies,macro-
scopicormicroscopic.butiftbesefactsrepresentobjectionstoa
real,ontologicalhnality, tbeyruncountertoarguments support-
ingapossible,operativehnality. |ftberewereaperfect,hnisbed
hnality, acompletesystemofrelationsoforganicagreement,tbe
veryconceptofhnalitywouldbavenomeaningasaconcept,asa
plan andmodelfortbinkingaboutlife,fortbesimplereasontbat
tberewouldbenogroundsfor tbougbt,nogroundsfortbinking
intbeabsenceofalldisparitybetweenpossibleorganizationand
realorganization.Tbetbougbtofhnalityexpressestbelimitation
oflife'shnality. |ftbisconceptbas ameaning, itisbecauseitis
tbeconceptofameaning,tbeconceptofapossible,andtbusnot
guaranteed, organization.
|nfacttbe explanation of tbe rarityof biocbemical diseases
liesintbefacttbatbereditarymetabolicanomaliesoftenremain
biddenasnonactivatedtendencies. |ntbe absence ofcbanceen-
counterswitbtbiscomponentoflife'senvironmentortbateffect
ofvitalcompetition,tbeseanomaliescanbeignoredbytbeirbear-
ers. ]ustasnotallpatbogenicgermsdetermineaninfectioninany
bostunderany circumstances, so not all biocbemicallesions are
someone'sdisease. |n certainecologicalcontextsitevenbappens
tbattbeyconferacertainsuperiorityontbosewbomusttbenbe
called tbeir beneb ciaries. |nman, forexample, a dehciency in
glucose-6-pbospbate-debydrogenasebasbeendiagnosedonlywben
antimalarialdrugs (quinine) were administeredtoblacks in tbe
United >tates. Now accordingto Lr. Uenri |quignot.
Wben we study bow an enzymatic disease, wbicb isgenetic,
couldmaintainitselfintbeblackpopulation,werealizetbat
tbesesubjectsareinsomucbbettersbapetbattbe'sickpeo-
pleahlictedwitbtbisdisturbanceareparticularlyresistantto
malaria. Tbeirancestorsin blackAfricawere'normalpeo-
plein relation tootberswbowereunht, sincetbeywerere-
sistantto malariawbiletbe otbers diedfrom it.
Wbilerecognizingtbatcertaininnatebiocbemical errors re-
ceivetbeireventualpatbologicalvaluefromarelationbetweentbe
organismandtbeenvironment, ascertainlapsesormistakenacts,
accordingto!reud,receivetbeirvalueassymptomsfromarela-
tion toa situation, we aretakingcarenotto dehnetbenormal
andtbepatbologicalintermsoftbeirsimple relationtotbepbe-
nomenonofadaptation.Afteraquarterofacentury,tbisconcept
basreceivedsucbanapplicationinpsycbologyandsociology, often
inopportune, tbatitcanonlybe used intbemost critical spirit,
eveninbiology.Tbepsycbosocialdehnitionoftbenormalinterms
ofadaptednessimpliesaconceptofsocietywbicbsurreptitiously
andwronglyassimilatesittoanenvironment,tbatis,toasystem
ofdeterminismswbenitisasystemofconstraintswbicb,already
andbeforeallrelationsbetweenitandtbeenvironment,contains
collectivenormsforevaluatingtbequalityof tbeserelations. To
2 82
debneabnormalityintermsofsocialmaladaptationismoreorless
to accepttbe ideatbattbe individualmustsubscribeto tbefact
of sucbasociety, bencemust accommodate bimself toitastoa
reality wbicb isattbesame time agood. becauseof tbe conclu-
sionsof ourhrstcbapter, itseemslegitimatetoustobeableto
refusetbiskindofdehnitionwitboutbeingcbargedwitbanarcbism.
|f societies are badly unib ed sets of means, tbey can be denied
tberigbttodehnenormalityintermsof tbe attitudeof instru-
mentalsubordinationwbicbtbeyvalorizeundertbenameofad-
aptation.Atbottom, tbis conceptofadaptation,transportedon
tbeterrainofpsycbologyandsociology,retumstoitsoriginalmean-
ing. |tisapopularconceptdescribingtecbnicalactivity. Vanadapts
bis tools andindirectly bis organs and bebavior to tbis material,
ortbatsituation. Attbemomentof itsintroductionintobiology
intbenineteentbcentury, tbeconceptpreservedtbemeaningof
arelationofextemality,ofconfrontationbetweenanorganicform
andanenvironmentopposingit,fromitsdomainof importation.
Tbisconceptbassincebeentbeoreticallyconceivedasstartingnom
two inverseprinciples,teleological and mecbanist. According to
one,tbelivingbeingadaptsitselftoconformtotbesearcbformnc-
tionalsatisfaction,accordingtotbeotber,tbelivingbeingisadapted
undertbeeffectofnecessitiestbat may bemecbanical, pbysico-
cbemicalorbiological(tbeotberlivingcreaturesintbebiospbere).
|ntbehrstinterpretation,adaptationistbesolutiontoaproblem
ofanoptimumformingtbefactualdataoftbeenvironmentand
tbelivingbeing'sdemands,intbesecond,adaptationexpressesa
state ofequilibrium, wbose lowerlimitdehnestbeworstfortbe
organism,wbicbistberiskof deatb. butinbotbtbeories,tbeen-
vironmentisconsideredasapbysicalfact,notasabiologicalfact,
asanalreadyconstitutedfactandnotasafacttobeconstituted.
bycontrast, iftbeorganismenvironmentrelationisconsidered
astbeeffectofareallybiologicalactivity,astbesearcbforasitu-
ationin wbicb tbe livingbeingreceives, insteadof submits to,
in|luences andqualitieswbicbmeetits demands, tbentbeenvi-
ronmentsinwbicbtbelivingbeingshndtbemselvesarecarvedout
bytbem,centeredontbem.|ntbissensetbeorganismisnotthrown
intoanenvironmentto wbicbbemustsubmit,butbe structures
bisenvironmentattbesametimetbatbedevelopsbiscapacities
as anorganism. '
Tbisisparticularlytrueofenvironmentsandmodesoflifepe-
culiartoman,attbebeartoftecbnicaleconomicgroupswbicb,
inagivengeograpbicalenvironment,arecbaracterizedlessbytbe
activitieswbicbareofferedtbemtbanbytbosewbicbtbeycboose.
Undertbeseconditionstbenormalandabnormalaredetermined
less bytbe encounter of two independent causal series, tbe or-
ganismand tbe environment, tban by tbe quantityof energy at
tbe disposal of tbe organic agent for delimiting andstructuring
tbisheldof experiences andenterprises,calleditsenvironment.
but, you will ask, wbere is tbe measure of tbis quantity of en-
ergy?|tistobesougbtnowbereotbertbanintbebistoryofeacb
oneof us. Lacbofushxesbisnormsbycboosingbismodelsof
exercise. Tbe norm ofa long-distance runner is not tbat of a
sprinter. Lacb of us cbanges bis norms accordingto bis ageand
formernorms. Tbenormoftbeformersprinterisnottbatofa
cbampion. |t isnormal, tbat is, inconformity witb tbebiological
lawofaging,tbattbeprogressivereductionoftbemarginsofse-
curityinvolvesloweringtbetbresboldsofresistancetoa_ressions
fromtbeenvironment.Tbenormsofanoldmanwouldbavebeen
considereddehcienciesintbesamemanj ustreacbingadultbood.
Tbisrecognitionoftbeindividualandcbronologicalrelativityof
normsisnotskepticisnibeforemultiplicitybuttoleranceofvari-
ety. |ntbe 1 943 Essay we called'normativity tbebiological ca-
pacitytocballengetbeusualnormsincaseofcritical situations,
andproposedmeasuringbealtbbytbegravityoftbeorganiccri-
ses wbicbaresurmountedbytbeestablisbmentofanewpbysio-
logical order."
|ntbeadmirable,movingpagesof The Birth c the Cinic, Vicbel
!oucaultbassbownbowbicbatmade'tbemedicalgazepivoton
itself,inordertocalldeatbtoaccountforlife. "Notbeingapbysi-
ologist, we do not presume to believe tbat in tbe same way we
bavecalleddiseasetoaccountforbealtb. |tisverycleartbattbat
iswbatwewouldbavewantedtodosoasnottobideourdeligbt
inbavingfoundafteralltbeabsolutionofourformerambitionin
Lr. Uenri |quignot.
|ntbepastalltbepeoplewbotriedtobuildascienceof tbe
normalwitboutbeingcarefultostartfromtbepatbologicalcon-
sideredastbeimmediategivenbaveendedupinoftenridicu-
lousfailures.70
As we are quite persuaded of tbe fact,analyzedabove, tbattbe
knowledgeoflife,liketbeknowledgeofsociety,assumestbepri-
orityofinfractionoverregularity,wewouldliketoendtbesenew
redectionsontbenormalandtbepatbologicalbysketcbingapar-
adoxicalpatbologyoftbe normal man, by sbowing tbattbecon-
sciousnessofbiologicalnormalityincludestberelationtodisease,
tberecoursetodiseaseastbeonlytoucbstonewbicbtbisconscious-
ness recognizes andtbus demands.
|nwbatsense istbenormalman'sdisease to beunderstood?
Notin tbe sense tbatonly tbenormalman canbecome sick, as
onlytbe ignorant canbecomewise. Notintbesensetbatsligbt
accidentsbappento disturbwitboutnonetbeless alteringa state
ofequalityandequilibrium.colds,beadacbes,arasb,colic,every
accidentwitbouttbevalueofasymptom,awamingwitboutalarm.
bydiseaseoftbenormalmanwemustunderstandtbedisturbance
wbicb arises in tbe course of time from tbepermanenceof tbe
normalstate,fromtbeincorruptibleuniformityoftbenormal,tbe
diseasewbicbarisesfrom tbedeprivationofdiseases,fromanex-
istencealmostincompatiblewitbdisease.|tmustbeadmittedtbat
tbenormalmanknows tbat beissoonlyinaworld wbereevery
manisnotnormal,consequentlybeknowsbeissusceptibletodis-
ease,asagoodpilotknowsbecanrunbissbipaground,asanur-
banemanknowsbecancommitablunderq]. Tbenormalman
feelsbimselfcapableofrunningbisbodyaground,butexperiences
tbe certitude of repelling tbe eventuality. |n tbe caseof disease
tbenormalmanisbewbolivestbeassuranceofbeingabletoar-
restwitbinbimselfwbatinanotberwouldrunitscourse. |norder
fortbenormalmantobelievebimself so, andcall bimselfso, be
needsnottbe foretaste of disease but its proj ectedsbadow.
|ntbelongrunamalaisearisesfromnotbeingsickinaworld
wberetberearesickmen.Andwbatiftbiswerenotbecauseone
is stronger tban tbe disease or stronger tban otbers, but simply
becausetbeoccasionbasnotpresenteditself?Andwbatif,intbe
end,wbentbe occasion does arise, onewere tosbow oneself as
weak,asunpreparedas,orperbapsmoresotbanotbers?Tbustbere
arisesintbe normal manananxietyaboutbaving remainednor-
mal,aneedfordiseaseasatestofbealtb,tbatis,asits proof, an
unconscioussearcbfordisease,aprovocationofit. Normalman's
diseaseistbeappearanceofafaultinbisbiologicalconhdencein
bimself
Oursketcbofpatbologyisobviouslyahction.Tbeanalysesfor
wbicbitsubstitutescanberapidlyreconstitutedwitb|lato'sbelp.
Yettbatiswbatwesayliterally wesaytbattbepbysicianerred
andtbecalculatorandtbescboolmaster. but tbetrutb,| take
it, is,tbateacboftbeseinsofarasbeistbatwbicbweentitle
286
bimnevererrs,sotbat,speakingprecisely, sinceyouaresucb
a sticklerfor precision, no craftsman errs. !or itiswben bis
knowledgeabandonsbimtbatbewbogoeswronggoeswrong
wben be is not a craftsman. ''
Letusapplywbati ssaidabove oftbe doctortobis client. We
sballsaytbattbebealtbymandoesnotbecomesickinsofaras be
isbealtby. Nobealtbymanbecomes sick, forbeissickonlyinso-
far as bis bealtbabandonsbimandintbis beisnotbealtby. Tbe
so-calledbealtbymantbusis not bealtby. Uisbealtbisanequilib-
riumwbicbberedeemsoninceptiveruptures. Tbemenaceofdis-
ease isone of tbecomponentsof bealtb.
E
p
ilogue
Undoubted|yourconceptionoftbenorma|isveryarcbaic,wbi|e
itis undoubted|ybecauseitis aswaspointedouttousin1943,
aconceptionof|ifesucbascanbeformedwbenoneisyoung. A
judgmentwbicbwedidnotintendbasde|igbtedusandweaskto
bea||owedtoapp|yittoourse|ves.Tbenotionoftbisidea|wbicb
istbenorma|isidentihedwitbtbepreviouseupboricstateoftbe
subjectwbobasjustfa||ensick... . Tbeon|ypatbo|ogyascertained
attbetimewasapatbo|ogyofyoungsubjects.
, ,
'Andundoubt-
ed|yittooktbetemerityofyoutbtobe|ieveonese|fequa|totbe
taskofastudyofmedica|pbi|osopbyonnormsandtbenorma|.
Tbedifhcu|tyofsucbanundertakingmakesonetremb|e.Weare
aware of tbis today aswe comp|ete tbese pages of resumption.
Witbtbis confession, tbe readerwi||measurebowmucbwe, in
conformitywitbourdiscussiononnorms,bavereducedourown
witbtime.
Note s
I NTRODUCTI ON
1 . Fontenelle, Priace a J'histoire de J'academie, "Oeuvres" edition, 1790, Vol.
6, pp. 73-74. Canguilh
e
m cites this text in his Introduction a J'histoire des sciences,
Paris, 1970, Vol . 1, pp. 7-8.
2. On this theme, see Canguilhem's IdeoIogie et rationalite dans J'histoire des
sciences de la vie, Paris, 1977, p. 2 1 .
3 . Cf. Canguilhem's Etudes d'histoire et de philosophie des sciences, Paris, 1968,
p. 1 7.
4. Canguilhem again takes up the example dealt with by Florkin in the latter's
A Histor i Biochemistr, Amsterdam, 1972-75.
5. Ideologie et rationalite, p. 14.
6. On the relation between epistemology and history, see in particular the
"Introduction" to Ideologie et rationalite, pp. 1 1 -29.
7. Etudes, p. 239.
8. Canguilhem, La connaissance de la vie, 2nd ed., Paris, 1 965, p. 88.
9. Cf. Canguilhem's La formation du concept de riexe aux XVIIe et XVIIr
siecles, Paris, 1955.
SECTI ON I
1 . The references in brackets refer to the Bibliography. The first number
(roman) refers to the corresponding numbered entry in the Bibliography, the
second number (in italics) to the volumes, pages or articles in the cited work.
2. On the relations between Comte and Robin, see Gentry [42] and Klein
[64].
3. This text is quoted on p. 33 in fne. Nietsche's lines are from The Will to
Power (No. 47). Translated by WaIter Kaufan and R. J. Hollingdale, New York,
Vintage, 1968.
4. A very recently made bibliographical discovery confirms our choice. The
pathological dogma we want to discuss was expounded without reticence or res
ervation by Charles Daremberg in 1864 in the Joural des debats, under the aegis
of Broussais, Comte, Littre, Charles Robin and Claude Bernard [29].
5. For Comte's biological and medical reading between 1817 and 1824, when
"he was preparing to become not a biologist but a philosopher of biology," see
H. Gouhier [47, 237].
6. A good exposition of all Broussais's ideas can be found in [14; 29; 13 bis,
1I1; 83].
7. I talics ours.
8. Italics ours.
9. [The following English versions of Brown's Elementa medicinae are taken
from the 1 806 Philadelphia edition; the page references are from that edi
tion - Trns.]
1 0. * Cf. my recent study "John Brown, La theorie de l'incitabilite de l'or
ganisme et son importance historique. " In the Proceedings i the XlII Interational
Congress i the History i SCience, Section IX, The History i BioloB (including
the fundamentals of medicine), Moscow, Editions Nauka, 1974, pp. 141-146.
1 1 . Bernard willed his unpublished papers to d'Arsonval. Cf. C Bernard,
Pensees, notes detachees, preface by d'Arsonval (j. -8. Bailliere, 1937). These papers
have been inventoried by Delhoume but so far he has only published fagments.
* Today a Catalogue des manuscripts de C Berard is available, edited by M. -D.
Grmek, Paris, Masson, 1967.
1 2. Pasteur in the article on C. Bernard, ses travaux, son enseignement, sa
methode [93].
NOTES
1 3. See Pierre Mauriac's Claude Bera1d [81] and Pierre Lamy's Caude Berard
et le materialisme [69].
1 4. For example, this is the case of Henri Roger in his Introduction d la
miecine, Paris, G. Carn et C. Naud, 1 899. The same is true of Henri Claude
and Jean Camus in their PatholoOie oenerale, Paris, J. -B. Bailliere et fls, 1909.
1 5. Physiology course on La constance du milieu interieur [The Constancy of
the Interior Environment], Faculty of Medicine, Toulouse, 1938-39.
1 6. Course in pharmacology, Strasbourg Faculty of Medicine, 1941-42.
1 7. This expression, "inconspicuous infection," seems to me to be incorrect.
Infection is invisible only from the clinical point of view and on the macroscopic
level. But from the biological point of view and on the humoral level, infection
is apparent since it can be expressed in terms of the presence of antibodies in
the serum. Nevertheless, infection is only a biological fact, a modifcation of
the humors. An inapparent infection is not an inapparent disease.
1 8. Bernard says that he never succeeded in detecting sugar in the tears of
a diabetic, but today it is an established fact; cf. Fromaget and Chaix, "Glucides,"
Physiolooie, fasc. 3, year 2, p. 40, Paris, Hermann, 1939.
1 9. * After the original publication of this study (1 943) an examination of
Bernard's ideas was undertaken by Dr. M. -D. Grmek, "La conception de la sante
et de la maladie chez Claude Bernard" [cf. Bibliography to Section III
20. Nature and L!, Cambridge [Eng.], 1934, p. 5. Quoted by Koyre in a
report in Recherches philosophiques IV (1 934-35), 398.
2 1 . Besides, Hegel understood this perfectly well, cf. Wissenschc der LoOik
(Chapter I, 3).
22. * These questions were studied later by de Laet and Lobet, Etude de la
valeur des oestes priessionels [Study of the Value of Professional Gestures], Brussels,
1949, and by A. Geerts, L'indemnisation des lesions corporelles d travers les Goes
[Compensation for Bodily Injuries Through the Ages], Paris, 1962.
23. In his Dictionnaire etymoloOique orec et latin (1942) A. Juret proposes this
same etymology for the word "anomaly. "
24. This i s the actual expression used by Flourens.
25. Report of the Danish Expedition on the North East Coast of Greenland
1906-1908. Meddelelser om Grinland, p. 44, Copenhagen, 1917. Quoted after
R. Isenschmidt, "Physiologie der Warmeregulation," in Handbuch der norm. u.
path. Physiologie 17, p. 3, Berlin, Springer, 1926.
26. * We no longer take the liberty of asking ourselves this today.
27. Wertphilosophie und Ethik, p. 29, 1939, Vienna-Leipzig, Braumtiller.
28. This number of 40 pulsations seems less extraordinary than Sigerist's
example gives us to understand, when one is acquainted with the influence of
athletic training on cardiac rhythm. The pulse decreases in frequency as training
advances. This decrease is more pronounced in a thirty-year-old subject than
in a twenty year old. It also depends on the kind of sport engaged in. In an
oarsman a pulse of 40 indicates very good form. If the pulse falls below 40,
one speaks of overconditioning.
29. Merleau-Ponty's work, Structure du comportement (Alcan, 1942), has just
done a great deal to spread Goldstein's ideas.
* A French translation of [Goldstein's] Azbau des organismus by E. Burckardt
and J . Kuntz appeared in 1 951 (Gallimard) under the title La structure de
l' organisme.
30. [There is a play on words in the French: " . . . medecin qui dit: Mena
gez-vous! 'Me menager c'est bien facile a dire, mais j 'ai mon menage [house
hold]"'; p. 1 30 - Trans. ]
3 1 . * On this point see W. B. Cannon, The Wisdom ci the Body, Chapter XIV:
"The Margin of Safety in Bodily Structure and Functions," New York, 1 932.
32. It may be objected, perhaps, that we have a tendency to confuse health
and youth. However, we are mindful of the fact that old age is a normal stage
of life. But at the same age one old man will be healthy who demonstrates a
capacity to adapt or repair organic damages which another may not demonstrate,
for example, a good, solid knitting of the neck of a fractured femur. The beautiful
old man is not merely poetic fction.
33. Singer in his otherwise noteworthy section devoted to Harvey insists
rather on the traditional character of his biological conceptions, so that Harvey
NOTES
would have been an innovator because of his methodological correctness and
despite his doctrinal assumptions [108].
34. * Cf. M. -D. Grmek's study "Opinion de Claude Bernard sur Virchow
et la pathologie cellulaire," in Castalia (Milan), January-June 1965.
35. Circumstances have not allowed us to refer directly to Ricker's works.
36. * In the Soviet Union it is A. -D. Speransky, Fondements de la theorie de
la meecine, 1 934 [English translation, New York, Interational Publishers, 1936;
German translation, 1950]. Cf Jean Starobinski's study, "Une theorie de l'origine
nerveuse des maladies, " Critique, No. 47, April 1 951 .
37. It i s understood that we are not dealing here with mental illnesses where
the patients' ignorance of their state often constitutes an essential aspect of the
disease.
SECTI ON 1 1
1 . Francis Courtes, maftre-assistant at the Montpellier Faculty of Letters and
Social Sciences.
2. Cf supra, pp. 78-86.
3. Principes de medecine experimentale, p. 1 70.
4. Cf my article "La pensee de Rene Leriche," in Revue philosophique 146
(1 956), 31 3-31 7.
5. Ch. Kayser, "Le maintien de l'equilibre ponderal," Acta neuroveBetativa
24, 1-4, Vienna, 1963.
6. La terre et les reveries du repos (Paris, 1 948), pp. 41-42.
7. I t would be possible and fruitful -but this is not the place -to set up
semantic families of concepts representing the kinship of normal and abnormal,
for example, the set turbid, tortured, tortuous, etc., and the set oblique, deviated,
athwart, etc.
8. Tristes tropiques, 38, "A Little Glass of Rum."
9. "Aux origines de la pensee sociologique," Les temps moderes (December
1 962).
1 0. Descartes had already said: "Although health is the greatest of all our
bodily possessions, it is nevrtheless the one about which we reflect the least
and which we savor least. The knowledge of the truth is like the health of the
soul: as long as we have it we don't think any more about it. " (Letter to Chanut,
31 March 1649. )
1 1 . The Sophist, 239b, in The Sophist and the Statesman, translation and
introduction by A. E. Taylor. Edited by R. Klibansky and E. Anscombe (London,
Nelson, 1 961 ). [Orthology: the art of using words correctly ( Webster's New
Interational Dictionary, 2nd ed. 1958). ]
1 2. Cf. Pierre Guiraud, La Brammaire, Presses Universitaires de France, 1958,
p. 109.
1 3. Remarques sur la lanBue jam;aise (1647), preface.
1 4. Establishment of conscription and the medical examination of conscripts; .
establishment of national studfarms and remount depots.
1 5. Op. cit. , p. 109.
1 6. Cf Jacques Maily, La normalisation (Paris, Dunod, 1946), pp. 157 sq. Our
brief account of normalization owes much to this work which is useful for its
clarity of analysis and historical information as well as for its references to a
study of Dr. Hellmich, Vom Wesen der NormunB (1927).
1 7. Fables, VI, 4, "Jupiter et le Metayer" [Jupiter and the Sharecropper].
1 8. Julien Freund, L'essense du politique (Paris, Sirey, 1965), p. 332.
1 9. Op. cit. , p. 293
20. Cf. Bergson, The Two Sources i Morality and ReliBion: "Whether human
or animal, a society is an organization; it implies a coordination and generally
also a subordination of elements; it therefore exhibits, whether merely embodied
in life or, in addition, specifically formulated, a collection of rules and laws."
(Trans. by R. Ashley Audra and Cloudesley Brereton, Garden City, New York,
Doubleday, 1954, p. 27. )
2 1 . Cour phil. pas. , 48" Lecon (ed. by Schleicher, v. IV, p. 170).
22. Ibid. , p. 1 77.
23. Ibid. , p. 1 76.
24. Ibid. , p. 1 83.
25. SJst. de pol. pas. , II, p. 304.
26. Ibid. , p. 335.
NOTES
27. Pp. 148-1 55 of that work. Is it uninteresting to recall that at the end
of the nineteenth century the French Anny's intelligence department, disagreeably
implicated in the Dreyfus affair, bore the name of department of statistics.
28. Le Beste et la parole: Vol. I: Technique et lanBaBe (Paris, 1964), p. 1 14.
29. Le Beste et la parole: Vol. 11: La memoire et les rythmes (Paris, 1965), p. 34.
30. Ibid. , p. 63.
3 1 . Tristes tropiques, 38, p. 387.
32. London, Cassell, 5th ed. , 1910.
33. Ibid. , p. 5.
34. Ibid. , p. 6.
35. We have commented at greater length on these reflections of Chesterton
in our lecture: "Le probleme des regulations dans la societe" (Cahiers de l'Alliance
Israelite Universelle, No. 92, Sept.-Oct. 1955).
36. Op. cit. , p. 5.
37. Out i the NiBht: A BioloBist's View i the Future (New York, Vanguard,
1935).
38. Ibid. , p. 1 22.
39. Cf. Julian Huxley, Soviet Genetics and World Science: Lysenko and the MeaninB
i Heredity (London, Chatto and Windus, 1949).
40. Cannon borrowed the title The Wisdom i the Body from the illustrious
English physiologist, Starling.
41 . Ibid. , p. 24.
42. Cf. supra pp. 142-144.
43. Duyckaerts, La notion de normal en psycholoBie clinique (Paris, Vrin, 1954),
p. 1 57.
44. Published by Gallimard, 1st edition 1 949; 2nd edition, 1958. The thesis
of evolution by dichotomy (split of an animal group into an innovative and a
conservative branch) is taken up again by Vandel in his article on "L'evolutionnisme
de Teilhard de Chardin," Etudes philosophiques, 1965, No. 4, p. 459.
45. "In Darwin's teninology the vacant places in a given locality are less
free spaces than systems of life (habitat, mode of feeding, attack, protection)
which are theoretically possible there and not yet practiced. " "Du developpement
a l 'evolution au XIxe siecle," by Canguilhem, Lapassade, Piquemal, Ulmann, in
Thales 11 (1960), 32.
46. We are borrowing the core of our information on genetic homeostasis
from Ernest Bosiger's excellent study, "Tendances actuelles de la genetique des
populations," published in the Report of the XXVI Semaine de Synthese, La bioloBie,
acquisitions recentes (Paris, Aubier, 1965).
47. We could even say with A. Lwoff: "The living organism has no problems;
in nature there are no problems; there are only solutions," "Le concept d'infor
mation dans la biologie moleculaire," in Le, concept d'irormation dans la science
contemporaine (Paris, Les Editions de Minuit, 1965), p. 198.
48. arterI Bull. Northwester Universit Medical School 1 8 (Chicago, 1944),
22-32, Spring Quarter. This article was drawn to our attention and obtained
for us by Profs. Charles Kayser and Bernard Metz.
49. The Lancet I, 1 (1947); the article is reproduced in Concepts i Medicine,
edited by Brandon Lush (Pergamon Press, 1961).
50. Cf. supra, pp. 165-172.
5 1 . Tensions AfectinB International UnderstandinB: A Survey i Research (New
York, Social Science Research Council, 1 950), pp. 46-48. This work was brought
to our attention by Robert Pages.
52. Cf. Selye: "D'une revolution en pathologie," La nouvelle revue Jam;aise
(1 March 1 954), p. 409. Selye's principal work is Stress, Montreal, 1950. Pre
Viously, "Le syndrome general d'adaptation et les maladies de l'adaptation,"
Annales d'endocrinoloBie (1946), Nos. 5 and 6.
53. Principes de physiopatholoBie et de therapeutique Benerales [Principles of
General Physiological Pathology and Therapeutics], 3rd edition (Paris, Masson,
1963), p. 232.
54. Cf Charles Kayser: "The study of hyperventilation at high altitudes and
in the course of work has led to a serious revision of our conceptions of the
importance of reflex mechanisms in regulating breathing. The importance of
the heart's debit in the circulatory mechanism appeared in all its clarity only
when sportsmen and sedentary people had been studied exerting themselves.
NOTES
Sport and work pose a set of purely physiological problems which we must try
to clarify. " (PhysioloBie du travail et du sport , Paris, Hermann, 1947, p. 233. )
55. La raison et les remMes (Paris, Presses Universitaires de France, 1964),
p. 310.
56. Cf. on this subject Philippe Decourt, "Phenomenes de Reilly et syndrome
general d'adaptation de Selye," Etudes et Documents, I (Tangier, Hesperis, 1951).
57. "Les troubles fonctionnels en pathologie" (Opening lecture in the course
on medical pathology), in La Presse meicale, 103 (23 December 1936). This text
was reported to us by Fran<ois Dagognet.
58. Op cit. , p. 202.
59. Cf. supra, pp. 78-79.
60. Inborn Errors i Metabolism (London, H. Frowde, 1909).
61 . Cf. Tubiana, '''Le goitre, conception moderne," RevueJranaise d'etudes
cliniques et bioloBiques (May 1962), pp. 469-476.
62. For a classification of genetic diseases, cf. P Bugard, L'etat de maladie,
Part IV (Paris, Masson, 1964).
63. On this point cf. R. Ruyer, La cberetique et J'oriBine de l'inJormation
(Paris, 1954); and G. Simondon, L'individu et sa Benese physico-bioloBique (Paris,
1964), pp. 22-24.
64. Cf. S. Bonnefoy, ['intolerance hereditaire au fuctose (Medical thesis, Lyon,
1961).
65. Trite des maladies qu'il est danBereux de Bueir, by Dominique Raymond
(1757). New enlarged edition with notes by M. Giraudy (Paris, 1 808).
66. L'inadaptation, phenomene social (Recherches et debats du CCI. E, Fayard,
1964), p. 39. As can be seen from Dr. Pequignot's contribution to the above
mentioned discussion on inadaptation, he does not identify abnormal and
unftness, and our critical reservations in the following lines do not concer him.
67. Cf our study "Le vivant et son milieu" in La connaissance de la vie (Paris,
1 965).
68. Cf. supra, pp. 198-199.
69. Op cit. , p. 146.
2
99
70. Initiation a la meecine (Paris, Masson, 1961), p. 26.
7 1 . The Republic, with an English translation by Paul Shorey (Cambridge,
Mass., Harvard University Press, 1963), Book I, 340d (pp. 55 and 57).
72. H. Pequignot, Initiation a la medecine, p. 20.
3
00
Glos s ary of Medical Terms
This Glossary was prepared by Carolyn Fawcett and Robert Cohen. It is based
in part on Stedman's Medical Dictionary (22nd ed., Baltimore, Williams and
Wilkins, 1975).
achlorhydria: the absence of hydrochloric acid from the gastric juice.
adenoma: a benign tumor of epithelial tissue forming a gland or glandlike structure.
alkaptonuria: an acid secretion in the urine due to a specific, congenital enzymatic
lack.
aheolar pyorrhea: periodontitis.
anaphylaxia: lessened resistance and extreme sensitivity of tissues to the rein
troduction of foreign protein or other material.
ankylosis: stiffening or fxation of a joint.
aphasia: loss or impairment of the power to use or understand language in any
of its forms, resulting from a brain lesion, or sometimes from functional or
emotional disturbance.
apnea: absence of respiration.
apophyis: an outgrowth or projection, especially from a bone.
arefexia: a condition in which the reflexes are absent.
arteritis: inflammation involving the arteries.
asthenia: weakness, debility.
autophaBia: feeding upon oneself; maintenance of the nutrition of the whole
body by metabolic consumption of some of the body tissues.
3
0 1
axis cylinder: see neurite.
Basedow's disease: (also Graves's disease): toxic goiter (enlargement of the thyroid),
sometimes but not always accompanied by protrusion of the eyeballs.
calcemia: excess of calcium in the blood.
cardiac liver (cardiac cirrhosis): a liver disease resulting from prolonged congestive
heart failure.
cenesthesia: the general sense of bodily existence related to the functioning of
the internal organs.
convoluted tubule: convoluted portion of the functional unit of the kidney.
Cooley's anemia (thalassemia major): severe anemia due to an inherited disorder
of hemoglobin metabolism.
\
coxalBia (coxodynia): pain in the hip joint.
cuppinB BIasses: glasses used in cupping (a method once used to produce slow
bleeding by applying a glass cup to an opening in the skin to create a partial
vacuum).
cyanotic: relating to or marked by cyanosis, a dark bluish or purplish coloration
of the skin and mucous membrane due to defcient oxygenation of the blood.
cyclopia: a congenital defect in which the two eye orbits merge to form a single
cavity containing one eye.
cystinuria: excessive urinary excretion of cystine, an amino acid occurring in
protein, notably keratin and insulin.
diastase: an enzymatic mixture which converts starch into dextrin and maltose.
diathesis: a permanent (hereditary or acquired) condition of the body which
renders it liable to certain special diseases or metabolic or structural anomaly.
diuresis: excretion of urine, usually denoting large volume.
ectromelia: a congenital lack of one or more of the limbs.
edema: an accumulation of an excessive amount of fuid in cells, tissues or serous
cavities.
endocarditis: infammation of the lining membrane of the heart.
epiphysis: a part of a long bone which ossifes separately from that of the shaft
and which subsequently becomes fused to the main part of the bone, in some
cases in man as late as the twentieth year.
3
02
GLOSSARY OF MEDI CAL TERMS
erysipelas: a local febrile disease accompanied by diffused inflammation of the
skin, producing a deep red color.
exostosis: a bony tumor springing from the surface of a bone.
gastrectomy: removal of part or all of the stomach.
glycemia: presence of glucose in the blood.
glycogenesis: process of the formation of glycogen from glucose.
glycosuria: urinary excretion of carbohydrates.
hemeralopia: day blindness, or more generally, the inability to see as distinctly
in a bright light as in a dim one.
hemianopsia: loss of vision for one half of the visual feld of one or both eyes.
hepatiC aldolases: a class of enzymes (cleaving carbon bonds of aldohydes) found
in the liver.
Hodgkin 's disease: chronic enlargement of the lymph nodes due to a malignant
tumor of reticulum cells.
hyperchlorhydria: the presence of an abnormal amount of hydrochloric acid in
the stomach.
hyperglycemia: abnormally high concentration of glucose in the blood.
hypermyotonia: extreme muscular tonus.
hyperthermia: unusually high fever.
hypertonia: extreme tension of the muscles or arteries.
hypophysectomy: removal of the pituitary gland.
hypospadias: a developmental anomaly in the wall of the urethra which then opens,
in males, at a distance under the surface of the penis, and in females, directly
into the vagina.
hypothermia: body temperature below 98. 6 F
O
.
integumentar: relating to the enveloping membrane of the body (integument).
isles < Langerhans: cellular masses in the interstitial tissue of the pancreas,
composed of different cell types and comprising the endocrine portion of
the pancreas; they are the source of insulin and glucagon.
leukocyte: white blood cell.
Lif er bacillus: cornebacterium diphtheriae which, along with its highly potent
toxin, causes diphtheria.
miasma: noxious exhalations fonnerly regarded as the cause of malaria and of
various epidemic diseases.
monBolian trisomy: trisomy refers to an individual or cell with an extra chromo
some; in man a trisomic cell has forty-seven chromosomes. Trisomy charac
terizes the cells of almost all mongoloids.
necrosis: the pathologic death of one or more cells, or of a portion of tissue or
of an organ.
nephritis: inflammation of the kidneys.
neurite: axon.
neuroBlia: non-nervous cellular elements of nervous tissue, with supporting and
possibly metabolic functions.
neuTBlioma: a tumor developed from neuroglial cells.
neurolemma (or sheath i Schwann): a tubular cell that enfolds some nerve fbers.
neuroma: the old, general ten for any neoplasm derived from cells of the nervous
system.
pancreatectomy: removal of the pancreas.
parapleBia: paralysis of both legs and generally the lower trunk as well.
parenchyma: the distinguishing or specific cells of an organ as distinct from the
connective tissue framework.
Parkinson's disease (aralysis aBitans): a neurological disorder caused by degenerative
disease of the basal ganglia, associated with rigidity, tremor, poverty of
movement, odd posture, peculiar acceleration of gait.
pentosuria: excretion of one or more pentoses (simple sugars containing fve carbon
atoms) in the urine.
peripneumonia: old name for pneumonia.
phenylketonuria: an inherited metabolic defciency resulting in brain damage with
severe mental retardation and neurological abnonnalities.
phenylpyruViC imbecilit: see phenylketonuria.
phenylpyruvic oliBophrenia: see phenylketonuria.
phleBmasia: inflammation, especially when acute and severe.
phthiSiS: a wasting or atrophy; in particular (as used in this book) an obsolete
ten for consumption or tuberculosis of the lungs.
GLOSSARY OF MEDICAL TERMS
pithiatism: morbid condition curable by suggestion.
poldipsia: frequent drinking because of extreme thirst.
pophagia: excessive, eating.
polyuria: excessive excretion of urine.
Pott 's disease (tuberculous spondylitis): tuberculous infection of the spine.
pronation of the frearm: rotation of the forearm so that the palm faces backward
when the arm is at the side of the body.
pylorus: a muscular or myovascular device to open and close an orifi ce: in
Canguilhem's example, the opening from the stomach into the intestine.
reticulo-endothelial sstem: system of large macro phages or mononucleated cells
found in the linings of the sinuses and in the spleen, liver, lymph nodes,
bone marrow, connective system, etc. which ingest dead tissue and degen
erated cells, and form part of the body's immunity system.
sacralization: an anomaly of the fifth lumbar vertebra involving fusion with the
upper part of the sacrum (next to the lowest part of the spinal column).
scleroderma: a disease characterized by swelling and thickening of the skin
(hidebound disease).
sclerosis: a morbid hardening of any tissue or structure of chronic inflammatory
origin.
splanchnic: one of the nerves supplying the viscera.
spondyloSiS: breaking down or dissolution of the body of a vertebra.
stenosal: related to the narrowing of any canal.
sthenia: a condition of activity and apparent force.
supination of the forearm: rotation of the forearm so that the palm faces upward
when the arm is at the side of the body.
syringomyelia: a chronic disease involving cavities in the spinal chord, chara<terized
by muscular atrophy, especially of the upper extremities, loss of the senses
of pain and temperature with tactile sensibility retained.
tabes: progressive wasting or emaciation.
terrain (adapted from Robert): the state of an organism with regard to its
resistance to pathogenic agents or its predisposition to different diseases.
tetanus: a disease marked by painful tonic muscular contractions.
THE NORMAL AND T HE PATHOLOGICAL
tonus: a state of nonnal tension of the tissues by virtue of which the parts are
kept in shape and alert and ready to function.
tryptophane: a component of proteins.
tyrosine: a specifc amino acid present in most proteins.
uremia: excess of urea and other nitrogenous waste in the blood.
vasodilatation: dilation of the blood vessels.
Bibliographies
In the text the references in brackets refer to this Bibliography. The first number
(roman) refers to the corresponding number entry in this Bibliography; the second
number (in italics) to the volumes, pages or articles in the cited work.
S ECTI ON I
1 . Abelous, ] . -E. , "Introduction a l'etude des secretions internes," Traite de
physioloBie normale et patholoBique, 2nd ed. , Vol. IV. Paris, Masson, 1 939.
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doctrine de M. Broussais. Paris, Mequignon-Marvis, 1 821 .
4. Bernard, Cl., Lel;ons de physioloBie expeimentale appliquee a la meicine, 2 vols.
Paris, ]. -B. Bailliere, 1 855-1 856

5. -, Lelons sur les propriites phyioloBiques et les alterations patholoBiques des
liquides de 1'0rBanisme, 2 vols. Paris, ] . -B. Bailliere, 1 859.
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1865. (Introduction to the Study < Experimental Medicine. Translated by Henry
Copley Greene. New York, Macmillan, 1927; New York, Collier, 1961 . )
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Paris, Imprimerie imperiale, 1 867.
8. -, Lelons sur la chaleur animale. Paris, ]. -B. Bailliere, 1 876.
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1 0. -, Lelons sur les phenomenes de la vie communs aux animaux et aux veBetaux.
2 vols. Paris, ]. -B. Bailliere, 1 878-79. (Lectures on the Phenomena < Lie
Common to Animals and Plants. Translated by Hebbel E. Hoff, Roger Guillemin
and Lucienne Guillemin. Springfield, Ill. , Thomas, 1 974.)
1 1 . -, Philosophie; manuscrit ineit. Paris, Boivin, 1 938.
1 2. Bichat, X. , Recherches sur la vie et la mort. Paris, Bechet, 1 800; 4th ed. with
notes by Magendie, 1 822. (PhysioloBical Researches on Lie and Death. Translated
by E Gold, with notes by Magendie translated by George Hayward. Boston,
Richardson and Lord, 1 827. )
1 3. -, Anatomie Benerale appliquee a la physioloBie et a la meecine. Paris, Brosson
and Chaude, 1 801 ; new ed. by Beclard, 1 821 . (General Anatomy Applied to
PhysioloBY and Medicine. Translated by George Hayward, 2 vols. Boston,
Richardson and Lord, 1 822. )
1 3
b
i
s
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comme base de la philosophie. Paris, Perisse, 1 845. (In Volume 1 1 , see HaIler;
in Volume Ill, see Pinel, Bichat, Broussais.)
1 4. Boinet, E., Les doctrines meicales. Leur evolution. Paris, Flammarion, n. d.
1 5. Bordet, J. , "L resistance aux maladies. " Encyclopeie jam;aise, Vol. 6, 1 936.
1 6. Bounoure, L. , L'oriBine des fellules reproductrices et le probJeme de la liBnee
Berminale. Paris, Gauthier-Villars, 1 939.
1 7. Brosse, Th. , "L
;
energie consciente, facteur de regulation psycho-physiolog
ique," Evolution pschiatrique 1 (1 938). (See also Laubry and Brosse [70]. )
1 8. Broussais, E-J. -V., Traite de physioloBie appliquee a la patholoBie, 2 vols. Paris,
MBe Delauney, 1 822-23. (A Treatise on PhysioloBY Applied to PatholoBY.
Translated by John Bell and R. LaRoche. Philadelphia, H. C. Carey and I .
Lea, 1 826. )
1 9. -, Catechisme de la meecine physioloBique. Paris, MIle Delauney, 1 824.
20. -, De J'irritation et de la folie. Paris, MIle Delauney, 1 828. (On Irritation
and Insanity . . . . Translated by Thomas Cooper. Columbia, S.c., S. J. M'Morris,
1 831 . )
21 . Brown, John, Elementa medicinae. Edinburgh, C. EIliot, 1780-84, 2 vols. (The
Elements c Medicine. London, J. Johnson, 1788, 2 vols. in 1 ; The Elements c
Medicine. Philadelphia, printed by A. Bartram for Thomas Dobson, 1 806;
Elements de medecine . . . traduits de J'oriBinal latin . . . avec la table de Lynch
par Fouquier. Paris, Demonville et Gabon, 1 805. )
BIBLIOGRAPHIES
22. Cassirer, E., "Pathologie de la conscience symbolique," Joural de pschologie
26 (1 929), 289-336 and 523-566.
23. CastigHoni, A., Storia de/la medicina. Milan, Societa editrice "Unitas," 1927;
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i Medicine. Translated by E.B. Krumbhaar. New York, Knopf, 1941; 2nd rev.
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24. CauIIery, M. , Le probleme de l'evolution. Paris, Payot, 1931.
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26. Comte, A., "Examen du traite de Broussais sur I'irritation," 1 828. Appendix
to the Systeme de politique positive (cf [28]), Vol. IV, p. 21 6.
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1838. 40th lecture of the eours de philosophie positive. Paris, ed. by SchIeicher,
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28. -, Systeme de politique positive, 4 vols. Paris, Cres, 1 851-54; 4th ed., 1 91 2.
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33. Delmas-Marsalet, P, L'electrochoc tMrpeutique et la dissolution-reconstruction.
Paris, J. -B. Bailliere, 1 943.
34. Donald C. King, "Influence de la physiologie sur la Iitterature franaise de
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35. Dubois, R., Physiologie generale et comparee. Paris, Carre and Naud, 1 898.
36. Duclaux, J. , L'analse physico-chemique des Jonctions vi tales. Paris, Hermann,
1 934.
37. Dugas, L. , Le philosophe TModule Ribot. Paris, Payot, 1 924.
38. Ey, H. and Rouart, J., "Essai d'application des principes de Jackson a une
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39. Flourens, P, De la 10nBevite humaine et de la quantite de vie sur le Blobe. Paris,
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40. Fredericq, H. , Traite eJementaire de physioloBie humaine. Paris, Masson, 1 942.
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42. Gentry, V. , "Un grand biologiste: Charles Robin, sa vie, ses amities philoso
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43. Geoffroy Saint-Hilaire, I . , Histoire Benerale et particuliere des anomalies de
J'orBanisation chez J'homme et les animaux. 3 vols. and one atlas. Paris, ]. -B.
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44. Gley, E. , "Infuence du positivisme sur le developpement des sciences
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45. Goldstein, K. , "L'analyse de l'aphasie et l'etude de l'essence du langage, "
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47. Gouhier, H. , La jeunesse d'A. Comte et la formation du positivisme: Ill, A. Comte
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48. Guardia, J. -M. , Histoire de la meecine d'Hippocrate c Broussais et ses successeurs.
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49. Gurwitsch, A. , "Le fonctionnement
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de l'organisme d'apres K. Goldstein,"
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tablissement de la thermoregulation
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63. -, (with L. Dontchff and P Reiss), "Le rythme nycthemeral de la
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3
I I
65. Labbe, M., "Etiologie des maladies de la nutrition." In Maladies de la nutrition,
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66. Lagache, D. , "La methode pathologique," Encyclopedie franraise 8, 1 938.
67. Lalande, A. , Vocabulaire technique et critique de la philosophie. 2 vols. and 1
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68. Lamy, P, "L'Introduction a l'etude de la medecine experimentale. Claude
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70. Laubry, Ch. and Brosse, Th., "Documents recueillis aux Indes sur les 'Yoguis'
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73. -, "Introduction generale"; "De l a sante a la maladie"; "La douleur dans
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3
1 2
BIBLIOGRAPHIES
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THE NORMAL AND T HE PATHOLOGICAL
95. Prus, V. , De j'irritation et de la phlegmasie, ou nouvelle doctrine meicale. Paris,
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1 1 0. StroW, j. , "Albrecht von Hailer (1 708-1777). Gedenkschrift, 1938. " In xvr
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S ECTI ON I I
In addition to the works and articles cited as references in the preceding pages,
the list below contains other works which provided food for thought.
1 . Abrami, P, "Les troubles fonctionnels en pathologie" (Opening lecture of
the Medical Pathology Course, Faculty of Medicine, Paris), La Presse meicale,
23 December 1936.
2. Amiel, J. -L., "Les mutations: Notions recentes," Revuejanqaise d'etudes cliniques
et bioloBiques 10 (1 965), 687-690.
3. Bachelard, G., La terre et les reveries du repos. Paris, Corti, 1 948.
4. Bacq, Z. M. , Principes de physiopatholoBie et de therapeutique Benerales, 3rd ed.
Paris, Masson, 1 963.
5. Balint, M. , The Doctor, His Patient and His Illness. London, Pitman Medical
Publishing, 1957.
6. Bergson, H. , Les deux sources de la morale et de la reliBion. 20th ed. Paris, Alcan,
1 937. (The Two SoiIrces i Morality and ReliBion. Translated by R. Ashley Audra
and Cloudesley Brereton. Garden City, New York, Doubleday, 1 954.)
7. Bernard, Cl. , Introduction a J'etude de la medecine experimentale. 1 865. Paris,
Delagrave, 1 898. (An Introduction to the Study i Experimental Medicine.
Translated by Henry Copley Greene. New York, MacmilIan, 1 927; New York,
Collier, 1961. )
8. -, Principes de meecine experimentale. Paris, Presses Universitaires de France,
1947.
9. Bonnefoy, S. , "L'intolerance hereditaire au fructose." Thesis in medicine, Lyon,
1961.
1 0. Bosiger, E. , "Tendances actuelles de la genetique des populations. " La BioloBie,
acquisitions recentes. XVIe Semaine internationale de snthese. Paris, Aubier,
1 965.
1 1 . Bounoure, Louis, L'autonomie de J'etre vivant. Paris, Presses Universitaires
de France, 1949.
1 2. Brisset, Ch. et al. , L'inadaptation, phenomene social. Recherches et debat du
C. C.I.f Paris, Fayard, 1964.
/
BIBLIOGRAP HIES
1 3. Bugard, P, L'etat de maladie. Paris, Masson, 1964.
1 4. Canguilhem, G. , La connaissance de la vie, 2nd ed. Paris, Vrin, 1 965.
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Cahiers de J'Alliance Israelite universelle 92 (Sept.-Oct. 1955).
1 6. -,"La pensee de Rene Leriche," Revue philosophique (July-Sept. 1956).
1 7. -, "Pathologie et physiologie de la thyroide au XIxe siecle," Thales 9
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po
/
I ndex of Names
ABELOUs, 209.
Abrami, p, 272.
Addison, T. , 209.
Alembert (d'), 48, 248.
Althusser, L., 8.
Ambrossoli, 71 .
Aristotle, 87, 1 01 , 1 28, 253, 278.
Aschoff, 2 1 6, 2 1 8.
BACHELARD, G. , 8, 1 1 , 1 4, 239, 241 .
Bachelard, S. , 1 6.
Bacon, E, 41 .
Bacq, Z. M. , 271 , 273.
Banting, E G. , 80.
Basedow, 83.
Begin, 56, 57.
Beitzke, 2 1 6.
Benedict, 1 63, 1 74, 1 76.
Bergson, H. , 1 1 9, 1 29, 1 43, 1 94, 249.
3
2 1
Bernard, c. , 3 1 , 43-46, 61 , 63,
65-86, 95, 99, 1 00, 1 05-1 1 ,
1 28, 145, 1 47, 1 5 1 , ' 1 52, 1 53, 1 64,
1 86, 1 99, 207, 2 1 2, 220, 234, 235,
254, 260-61 , 275.
Best, 80.
Biasotti, 80.
Bichat, X. , 1 7, 47, 57, 61 -64, 76,
1 27, 1 28, 1 5 1 , 1 78, 223, 285.
Bier, 2 1 6.
Blainville (de), 63.
Blondel, c. , 1 1 5.
Boedeker, 78.
Bordet, J. , 1 38.
Bosider, E. , 297.
Boule, 1 73.
Bouin, J. , 1 2 1 .
Bounoure, L., 3 1 , 1 41 .
Bourdieu, 8.
Brosse, T, 1 65, 1 66, 1 69.
Broussais, 43, 47, 48, 5 1 , 54-61 , 75,
76, 1 04, 1 06, 1 1 1 , 1 46.
Broussonet, 1 07.
Brown, J., 48, 58-64, 234.
Brown-Sequard, 65, 209.
Brunschvicq, L., 35.
Buffon, 1 60.
Bugard,
p
, 299.
CAM US, J., 292.
Cannon, W. B. , 1 82, 1 83, 259, 260.
Cassirer, E., 1 88.
Castel, 8.
Caullery, 1 41 .
Cavailles, 8, 1 1 , 1 5.
Chabanier, 79.
Chaix, 293.
Chesterton, G. K. , 257, 258.
Chevalier, J. , 65.
Chevreul, 65.
Claude, H. , 292.
Comte, A. , 1 0, 43-54, 56, 61 -65,
75, 76, 99, 1 00, 1 07, 1 28, 1 86,
1 99, 250.
Cooley, 264.
Copernicus, 1 0.
Coue, 1 74.
Courtes, E, 295.
Cullen, 58.
DAGOGNET, E, 272, 298.
Dale, H. , 273.
Daremberg, c. , 42, 59, 60, 292.
Darwin, C. , 1 29, 1 41 , 1 42, 1 43, 259.
Decourt, p, 298.
Dejerine, 2 1 0.
Delbet,
p
, 2 1 3.
Delhoume, 3 1 .
Delmas-Marsalet, 1 90.
Descartes, R. , 8, 1 0, 1 1 , 1 28, 295.
Diderot, D. , 242, 245.
Donald-King, 45.
Dontcheff, 1 74.
Dubois, R. , 204.
Duclaux, J., 74.
Dugas, L., 45.
Duhem,
p
, 1 1 .
Dumas, G., 209.
Dumas, J. -B. , 73.
Duyckaerts, E, 297.
EIJKMANN, 1 63.
Ey, H. , 1 1 9, 1 88-90.
FEUERBACH, L., 1 0.
Fischer, B., 2 1 6.
Florkin, 291 .
Flourens, p, 1 46, 1 61 .
Foerster, 1 92.
INDEX OF NAMES
Fontenelle, 1 4, 291 .
Foucault, M. , 285.
Francis, I. , 244.
Fredericq, H., 69.
Freud, S., 208, 282.
Freund, ]. , 296.
Fromageot, 293.
GALILEO, 1 0, 1 3, 1 28, 205.
Galton, E, 1 56.
Garrod, A., 275.
Gauss, K. E, 1 56, 262, 268.
Genty, 291 .
Geoffroy Saint-Hilaire, I. , 42, 1 3 1 -35,
1 42, 2 1 0.
Gley, E., 65.
Glisson, 58.
Goldstein, 30, 86, 1 1 9, 1 8 1 -96, 1 98,
1 99, 204, 2 1 1 , 220.
Gouhier, H., 292.
Grave, 83.
Guirau
d
, p, 246, 295.
Guyenot, 1 30, 1 41 .
HALBWACHS, 1 56, 1 58-62.
Haldane, ]., 264.
HaIler, 42, 58.
Harvey, W., 42, 204.
Head, 86, 1 86.
" Hedon, L., 8 1 .
Hegel, G. , 1 0, 1 1 0.
Hering, 2 1 6.
Herxheimer, 2 1 3, 2 1 5, 22 1 , 225.
Hodgkin, T. , 226.
Honigmann, 21 9.
Houssay, 80.
Hueck, 2 1 6, 2 1 8.
H
h
sserl, 8., 8, 9, 1 1 .
Huxley, A., 280.
Huxley, ]., 297.
ISENSCijMIDT, 293.
Ivy, A., 265-67.
]ACCOUD, 71 .
]ackson, H. , 86, 1 86-90.
Jaspers, K., 1 1 6, 1 2 1 .
]oseph 11, 245.
]uret, A. , 293.
KANT, I . , 9, 1 0, 2 1 7, 233, 237, 242,
243.
Kayser, c. , 1 7476, 1 95, 295, 298.
Kehl, 3 1 .
Kelsen, H. , 248, 249.
Klein, 1 93, 291 .
Klineberg, 0. , 270.
Koch, R., 2 1 1 , 2 1 2.
Koyre, 1 1 , 1 4, 293.
LABBE, M. , 1 69.
Lacan, 8.
LaFontaine, 247.
Lagache, 3 1 , 1 1 5, 1 1 6, 1 1 7.
L
a
guesse, 80.
Lalande, A. , 1 25, 1 3 1 .
Lamy, P, 45, 66, 292.
Langerhans, P, 80, 1 48.
Lapassade, G. , 297.
Laplace, 1 08, 1 09.
Laubry, c. , 1 65, 1 66, 1 69.
Laugier, H. , 1 54, 1 8 1 , 265.
Lavoisier, 74, 1 08.
Lefrou, 1 72.
Leibniz, G. W. , 1 3, 1 37.
Lejeune, J., 279.
Lenin, v, 259.
Leriche, R., 30, 46, 91 -1 01 , 1 06,
1 1 9, 1 38, 1 91 , 1 92, 1 93, 1 96, 208,
2 1 1 , 235, 243.
Lerner, 264.
Leroi-Gourhan, A., 255.
Levi-Strauss, c., 242, 256.
L'Heritier, P, 1 42.
Liebig, 73.
Lifar, S. , 1 2 1 .
Lindhard, 1 77.
Littre, E., 44, 63, 65, 1 25, 1 3 1 , 244.
Lobo-Onell, 79.
Lomer, 225.
LoubatUres, A. , 8 1 .
Lubarsch, 2 1 6, 2 1 9.
Lukacs, G., 1 0.
Lussana, 7 1 .
Luther, M. , 1 0, 1 1 .
Lwoff, A., 20, 297.
Lynch, S. , 60, 61 .
MAGDEBOURG, 2 1 3.
Magendie, 63, 65, 1 09, 1 46.
Maily, J., 296.
Mainzer, 220.
Mao Tse-Tung, 270.
Marchand, 2 1 5, 2 1 8.
Marfan, 2 1 2.
Maria Theresa, 245.
Marx, K., 1 0, 246, 265.
Mauriac, P, 292.
Mayer, A. , 1 54, 1 64, 265.
Mendel, G. J. , 275.
Mendelssohn, 9, 1 0.
Mering (von), 80, 1 47, 2 1 0.
Merleau-Ponty, M. , 8, 29, 294.
Metchnikoff, 1 61 .
Metz, 8. , 298.
Meyer, R. , 2 1 6.
Meyerson, E., 1 1 0.
3
2
4
Michelangelo, 205.
Minkowski, E. , 1 1 5, 1 1 8-1 9.
Minkowski, 80, 1 47, 2 1 0.
Moliere, 77
Monglond, 1 71 .
Montesquieu, 209.
Moodie, R., 1 72.
Morgagni, 42, 223, 224.
Mosso, 1 76.
Mourgue, 1 87.
MUller, H. j., 259.
MUnsterberg, 2 1 5.
NAPOLEON, 245.
Naunyn, 2 1 0.
Naville, E. ,)09.
Nelaton, 1 83.
Newton, l. , 1 0, 1 3, 48, 1 09.
Nicolle, c., 85.
Nietzsche, E, 1 0, 22, 45.
Nolf, 69.
OMBREDANE, A., 1 87, 1 88.
Orfila, 1 46.
Osborne, 1 77.
Ovid, 241 .
Ozorio De Almeida, 1 63.
INDEX OF NAMES
--
PAGES, R., 298.
Pales, 1 72-74.
aracelsus, 1 03.
Passerson, 8.
Pasteur, L., 39, 85, 1 03, 292.
Pavy, 70.
Pequignot, H. , 282, 285, 299.
Peters, 2 1 5.
Pick, A., 1 87.
Pieron, 1 76.
Pinel, 42, 47.
Piquemal, J. , 297.
Pirquet (von), 2 1 2.
Plato, 244, 286.
Poincare, H. , 1 1 .
Porak, 1 66-69.
Pott, 2 1 2.
Pradine, 29.
Prchaska, 1 9.
Prus, V. , 1 06, 1 46.
QUETELET, A. , 1 54-59, 1 62, 261 .
RABAUD, 1 37.
Rathery, 8 1 .
Raymond, D. , 299.
Reilly, J., 27 1 , 272.
Reininger, 1 79.
Renan, 44, 45.
Ribot, 45, 1 1 6, 1 1 7.
Richelieu, 244, 246.
Richerand, 44.
Ricker, 2 1 3, 2 1 5, 2 1 6, 2 1 8-2 1 , 225.
Rickert, 2 1 5.
Robin, c. , 44, 63, 66, 1 25, 1 32, 29 1 .
Roessle, 2 1 6.
Roger, H. , 292.
Romains, J. , 77.
Rouart, 1 88-90.
Rousseau, J. J., 242.
Roux, W. , 2 1 6.
Ruyer, R., 299.
Ryle, J., 267, 268.
SABIANI, 3 1 .
Saint Roch; 2 1 0.
Saint-Simon, H. (de), 47.
Sartre, J. -P, 9.
Schwartz, A., 84, 1 48, 209.
Schwarz, 2 1 6.
Selye, H., 30, 271 , 272.
Sendrail, 1 38.
Sherrington, C. S. , 86.
Sigerist, E., 39, 42, 52, 1 03, 1 1 9, 1 8 1 ,
204, 207, 209.
Simondon, G., 299.
Singer, 294.
Socrates, 243.
Sorre, 1 59, 1 63, 1 69, 1 75.
Soula, 82.
Stahl, 1 03.
Starling, E. , 260.
Starobinski, J., 242.
Sydenham, T. , 42.
TAINE, 44.
Tarde, G., 253, 254.
Teissier, G. , 1 29, 1 42, 1 62.
Thibaudet, 1 64.
Toulouse, 1 76.
Tournade, 209.
Trew, 224.
Trousseau, 44.
Tubiana, M., 299.
VALERY, 1 39, 200.
Vallois, 1 73.
Vandel, A. , 263.
Van Helmont, 1 03.
Varigny, H. (de), 1 72.
Vaugelas, 244.
Vauvenargues, 1 86.
Velpeau, 224.
Vendryes, 1 52, 1 53.
Videl De La Blache, 1 62, 1 75.
Virchow, 207, 2 1 1 , 2 1 2, 224, 225.
Voelker, 1 74-77.
WARTER, J. , 1 93.
Weber, M. , 1 0.
Wei
g
ert, 2 1 5.
Weiss, A. G., 1 92, 1 93.
Weizsaecker, (van), 1 96.
Whitehead, A. , 1 09.
Willis, 1 9.
Windelband, 2 1 5.
INDEX OF NAMES
Wohler, 73.
Wolff, E. , 3 1 .
Wolflin, 205.
YOUNG, 8 1 , 1 47.
ZIEHEN, 2 1 6.

G Canguilhem The Normal and The Pathological

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The Normal

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